Affordable Access

deepdyve-link
Publisher Website

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

Authors
  • Hutchinson, Sharon J1, 2
  • Valerio, Heather3, 2
  • McDonald, Scott A3, 2
  • Yeung, Alan3, 2
  • Pollock, Kevin3, 2
  • Smith, Shanley3, 2
  • Barclay, Stephen3, 4
  • Dillon, John F5
  • Fox, Raymond6
  • Bramley, Peter7
  • Fraser, Andrew8, 9
  • Kennedy, Nicholas10
  • Gunson, Rory N11
  • Templeton, Kate12
  • Innes, Hamish3, 2
  • McLeod, Allan2
  • Weir, Amanda2
  • Hayes, Peter C13
  • Goldberg, David3, 2
  • 1 Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK [email protected]
  • 2 Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK.
  • 3 Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
  • 4 Glasgow Royal Infirmary, Glasgow, UK.
  • 5 Ninewells Hospital and Medical School, Dundee, UK.
  • 6 The Brownlee Centre, Glasgow, UK.
  • 7 Stirling Royal Infirmary, Stirling, UK.
  • 8 Aberdeen Royal Infirmary, Aberdeen, UK.
  • 9 Queen Elizabeth University Hospital, Glasgow, UK.
  • 10 University Hospital Monklands, Lanarkshire, UK.
  • 11 West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK.
  • 12 East of Scotland Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
  • 13 Royal Infirmary of Edinburgh, Edinburgh, UK.
Type
Published Article
Journal
Gut
Publisher
BMJ
Publication Date
Dec 01, 2020
Volume
69
Issue
12
Pages
2223–2231
Identifiers
DOI: 10.1136/gutjnl-2019-320007
PMID: 32217640
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Report this publication

Statistics

Seen <100 times