Long‐Term Mortality Following Hepatitis C Cure in a Real‐World Multinational Cohort

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Abstract
Background & Aims: Direct‐acting antiviral agents (DAA)‐mediated HCV cure correlates with better outcomes, but there are insufficient data on detailed mortality‐related risk factors after cure. This study sought to clarify mortality and associated risk factors post‐HCV cure. Methods: The study included HCV patients with sustained virological response following DAA (DAA‐SVR) from 39 REAL‐C centres in North America, Europe and Asia‐Pacific. The primary outcome was all‐cause mortality in DAA‐SVR patients. Mortality rate per 1000 patient‐years (PY) was calculated as the number of deaths divided by total PY multiplied by 1000. Results: A total of 10 034 DAA‐SVR patients (stratified by cirrhosis status: 5611 non‐cirrhosis, 4153 compensated, 270 decompensated) were included. With a median follow‐up of 4.76 PY, 4.9% (491) died. The all‐cause mortality rates were 6.2, 13.1, 60.0 and 10.4 per 1000 PY for patients without cirrhosis, compensated and decompensated cirrhosis, and overall patients, respectively. The 5‐year cumulative survival was 95.1% (94.5%–95.6%) overall, with the lowest rate of 73.9% (67.0%–79.5%) in decompensated cirrhosis. Non‐liver‐related death was the main cause in non‐cirrhosis (non‐liver‐related vs. liver: 5.2 vs. 0.8 per 1000 PY)/compensated cirrhosis (8.2 vs. 4.8 per 1000 PY), while liver‐related death was dominant in decompensated cirrhosis (24.7 vs. 33.8 per 1000 PY). Risk factors for higher mortality included age > 65 (3.2‐fold), male (1.5‐fold), cirrhosis (decompensated 7.6‐fold) and baseline DM (1.5‐fold). Conclusion: This study showed significant age, sex, fibrosis stage and DM differences in mortality and causes among DAA‐SVR patients. It provided granular subgroup data for precision medicine to support individualised care, future modelling studies and public health planning.
Funding Information
  • Gilead Sciences (IN‐US‐334‐4309)

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