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Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study

Research output: Contribution to journalArticle

  • Sharon J Hutchinson
  • Heather Valerio
  • Scott A McDonald
  • Alan Yeung
  • Kevin Pollock
  • Shanley Smith
  • Stephen Barclay
  • John F Dillon
  • Raymond Fox
  • Peter Bramley
  • Andrew Fraser
  • Nicholas Kennedy
  • Rory N Gunson
  • Kate Templeton
  • Hamish Innes
  • Allan McLeod
  • Amanda Weir
  • Peter C Hayes
  • David Goldberg

Related Edinburgh Organisations

Original languageEnglish
JournalGut
Early online date26 Mar 2020
DOIs
Publication statusE-pub ahead of print - 26 Mar 2020

Abstract

OBJECTIVE: Population-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland.

DESIGN: Through analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs.

RESULTS: Approximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015-18.

CONCLUSIONS: National scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same.

ID: 148080932