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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/09  
 
  2018 Sep;68(3):827-838.  
  doi: 10.1002/hep.29811.  
 
  Direct-acting antiviral sustained virologic response: Impact on mortality in patients without advanced liver disease.  
 
  Backus LI, Belperio PS, Shahoumian TA, Mole LA  
  https://www.ncbi.nlm.nih.gov/pubmed/29377196  
 
 

Abstract
 

The impact of sustained virologic response (SVR) on mortality after direct-acting antiviral (DAA) treatment is not well documented in patients without advanced liver disease and affects access to treatment. This study evaluated the impact of SVR achieved with interferon-free DAA treatment on all-cause mortality in hepatitis C virus-infected patients without advanced liver disease. This observational cohort analysis was comprised of 103,346 genotype 1, 2, and 3, hepatitis C virus-monoinfected patients without advanced liver disease, defined by FIB-4 ≤3.25 and no diagnosis of cirrhosis, hepatic decompensation, or hepatocellular carcinoma or history of liver transplantation, identified from the Veterans Affairs Hepatitis C Clinical Case Registry. Among 40,664 patients treated with interferon-free DAA regimens, 39,374 (96.8%) achieved SVR and 1,290 (3.2%) patients were No SVR; 62,682 patients constituted the untreated cohort. The mortality rate for SVR patients of 1.18 deaths/100 patient-years was significantly lower than the rates for both No SVR patients (2.84 deaths/100 patient-years; P < 0.001) and untreated patients (3.84 deaths/100 patient-years; P < 0.001). SVR patients with FIB-4 <1.45 and 1.45-3.25 had a 46.0% (P = 0.036) and 63.2% (P < 0.001) reduction in mortality rates, respectively, compared to No SVR patients and 66.7% (P < 0.001) and 70.6% (P < 0.001) reduction in mortality rates, respectively, compared to untreated patients. In multivariate Cox proportional hazard models controlling for baseline demographics, clinical characteristics, and comorbidities, SVR was independently associated with reduced risk of death compared to No SVR (hazard ratio, 0.44; 95% confidence interval, 0.32-0.59; P < 0.001) and compared to untreated patients (hazard ratio, 0.32; 95% confidence interval, 0.29-0.36; P < 0.001).

CONCLUSION:

Successfully treating hepatitis C virus with DAAs in patients without clinically apparent advanced liver disease translates into a significant mortality benefit. (Hepatology 2018).

 
Question posée
 
Evaluer l’impact de la SVR obtenue avec les traitements par anti-viraux directs sans interféron sur la mortalité toute cause chez les patients infectés par le VHC de génotype 1,2 ou 3 et sans fibrose sévère évaluée par FIB-4 ≤3.25 et donc sans cirrhose à partir d’une cohorte de plus de 100 000 patients mono-infectés traités comparés à 63 000 patients non traités.
 
Question posée
 
Les taux de mortalité sont significativement diminués chez les patients traités et répondeurs (SVR 97%).
 
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