Impact of sustained virologic response (SVR) on mortality in patients with advanced liver disease.

The impact of achieving SVR on all-cause mortality and the incidence
of hepatocellular carcinoma (HCC) was evaluated in a
cohort of more than 15,000 patients with advanced liver disease in
the Veterans Administrations Clinical case registry for hepatitis C.
Advanced liver disease was defined as FIB4> 3.25. 15,059 patients
who concluded treatment with directly acting antivirals (DAAs)
before September 2016 were included in the analysis. Mean
follow-up time was 1.6 years. 13,992 patients achieved SVR while
1,067 did not. Mortality rate was 12.3 deaths/100 patient years
of follow-up in those who did not achieve SVR compared to 2.6
in those who achieved SVR. Incident HCC rates were 11.5/100
patient years of follow-up compared to 1.9. The differences in allcause
mortality and incident HCC between those who achieved and
those who did not achieve SVR were highly statistically significant.

Ref; Backus et al. Hepatology 2019;69:487-497

Comment: This study confirms the benefits of clearing hepatitis
C also in patients with advanced liver disease. The difference
in mortality and incident HCC is dramatic between those who
achieved and those who failed to achieve SVR even though those
who did not achieve SVR were somewhat sicker at baseline compared
to those who achieved SVR. Nevertheless, the study clearly
confirms the benefits of clearing hepatitis C in advanced liver
disease.