1. Clinical outcome after SVR: ANRS CO22 HEPATHER
Design
Observational prospective cohort (France)
HCV-infected patients
Exclusion criteria: HBV co-infection, history of decompensated cirrhosis, HCC or liver transplant, treatment with IFN-RBV ± 1st generation PI, no follow-up
Survival time since enrolment or start of DAA (censoring date: July 1st, 2017, or death, or HCC, or decompensated cirrhosis)
Cox proportional hazards models with Inverse Probability of Treatment Weighting (IPTW) to quantify the impact of DAA (as a time dependent-covariate) on clinical outcomes
IPTW scores were obtained from a logistic model linking treatment with baseline covariates that confounded the treatment-outcome relationship
Study population
6 460 patients received DAA
8 462 patient-years of follow up, occurrence of 90 deaths, 164 HCC and 77 decompensation
2 835 patients did not receive DAA
patient-years of follow up, occurrence of 78 deaths, 57 HCC and 35 decompensation
ANRS CO22 HEPATHER
Carrat F, AASLD 2017, Abs. LB-28

2. Clinical outcome after SVR: ANRS CO22 HEPATHER
Baseline characteristics
Median (IQR) age: 56 (50-65) years
Male: 54%
Cirrhosis: 38%
Treatment experienced: 54%
Genotype
1: 66%
2: 7%
3: 11%
4: 12%
Diabetes: 12%
BMI ≥ 30 kg/m2: 13%
Hypertension: 29%
Association of baseline characteristics and DAA treatment during follow-up (multivariate analysis)
More likely to start DAA if
Age > 50 years
Genotype 3 (vs genotype 1)
Fibrosis F3-F4 (vs F0-F1)
Less likely to start DAA if
Female
Genotype 2 (vs genotype 1)
Treatment naive
ANRS CO22 HEPATHER
Carrat F, AASLD 2017, Abs. LB-28

3. Clinical outcome after SVR: ANRS CO22 HEPATHER
All-cause-deaths
Weighted survival (IPTW)
1.00
0.98
DAA -
DAA +
Deaths
DAA - : 78 vs DAA + : 90
0.96
0.94
HRIPWfixed for DAA (0.45;0.95), p=0.0258
0.92
0.90 5 10 15 20 25 30
Months
Hepatocellular carcinoma
Weighted survival (IPTW)
Decompensated cirrhosis
Weighted survival (IPTW)
1.00
1.00
0.98
0.98
0.96
0.96
HRIPWfixed for DAA (0.58;1.41), p=0.6533
0.94
0.94
HRIPWfixed for DAA (0.85;1.66), p=0.3178
0.92
0.92
0.90
0.90 5 10 15 20 25 30 5 10 15 20 25 30
Months
Months
HCC = DAA - : 57 vs DAA + : 164
Decompensation = DAA - : 35 vs DAA + : 77
ANRS CO22 HEPATHER
Carrat F, AASLD 2017, Abs. LB-28

4. Clinical outcome after SVR: ANRS CO22 HEPATHER
HRcrude (DAA+ vs DAA-)
HRIPWfixed (DAA+ vs DAA-)
2,43
Liver related deaths (n = 58)
0,68
1,23
Non liver related deaths (n = 81)
0,75
1,53
All cause deaths (n = 168)*
0,65
0,1 1 10
* 29 deaths were not yet adjudicated
ANRS CO22 HEPATHER
Carrat F, AASLD 2017, Abs. LB-28

5. Clinical outcome after SVR: ANRS CO22 HEPATHER
Conclusions
DAA was associated with
a decreased risk of death
The decrease in deaths was more pronounced for liver-related deaths than for non liver-related deaths
and no increased risk of HCC and decompensation
ANRS CO22 HEPATHER
Carrat F, AASLD 2017, Abs. LB-28