Victoria Hamill
Mortality rates among patients successfully treated for hepatitis C in the era of interferon-free antivirals: population based cohort study
Hamill, Victoria; Wong, Stanley; Benselin, Jennifer; Krajden, Mel; Hayes, Peter C; Mutimer, David; Yu, Amanda; Dillon, John F; Gelson, William; Velásquez García, Hector A; Yeung, Alan; Johnson, Philip; Barclay, Stephen T; Alvarez, Maria; Toyoda, Hidenori; Agarwal, Kosh; Fraser, Andrew; Bartlett, Sofia; Aldersley, Mark; Bathgate, Andy; Binka, Mawuena; Richardson, Paul; Morling, Joanne R; Ryder, Stephen D; MacDonald, Douglas; Hutchinson, Sharon; Barnes, Eleanor; Guha, Indra Neil; Irving, William L; Janjua, Naveed Z; Innes, Hamish
Authors
Stanley Wong
Jennifer Benselin
Mel Krajden
Peter C Hayes
David Mutimer
Amanda Yu
John F Dillon
William Gelson
Hector A Velásquez García
Alan Yeung
PHILLIP JOHNSON Phillip.Johnson@nottingham.ac.uk
Research Fellow
Stephen T Barclay
Maria Alvarez
Hidenori Toyoda
Kosh Agarwal
Andrew Fraser
Sofia Bartlett
Mark Aldersley
Andy Bathgate
Mawuena Binka
Paul Richardson
JOANNE MORLING JOANNE.MORLING@NOTTINGHAM.AC.UK
Clinical Associate Professor
Stephen D Ryder
Douglas MacDonald
Sharon Hutchinson
Eleanor Barnes
NEIL GUHA neil.guha@nottingham.ac.uk
Professor of Hepatology
WILLIAM IRVING mrzwi@nottingham.ac.uk
Professor of Virology
Naveed Z Janjua
Hamish Innes
Abstract
Objectives To quantify mortality rates for patients successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals and compare these rates with those of the general population.
Design Population based cohort study.
Setting British Columbia, Scotland, and England (England cohort consists of patients with cirrhosis only).
Participants 21 790 people who were successfully treated for hepatitis C in the era of interferon-free antivirals (2014-19). Participants were divided into three liver disease severity groups: people without cirrhosis (pre-cirrhosis), those with compensated cirrhosis, and those with end stage liver disease. Follow-up started 12 weeks after antiviral treatment completion and ended on date of death or 31 December 2019.
Main outcome measures Crude and age-sex standardised mortality rates, and standardised mortality ratio comparing the number of deaths with that of the general population, adjusting for age, sex, and year. Poisson regression was used to identify factors associated with all cause mortality rates.
Results 1572 (7%) participants died during follow-up. The leading causes of death were drug related mortality (n=383, 24%), liver failure (n=286, 18%), and liver cancer (n=250, 16%). Crude all cause mortality rates (deaths per 1000 person years) were 31.4 (95% confidence interval 29.3 to 33.7), 22.7 (20.7 to 25.0), and 39.6 (35.4 to 44.3) for cohorts from British Columbia, Scotland, and England, respectively. All cause mortality was considerably higher than the rate for the general population across all disease severity groups and settings; for example, all cause mortality was three times higher among people without cirrhosis in British Columbia (standardised mortality ratio 2.96, 95% confidence interval 2.71 to 3.23; P<0.001) and more than 10 times higher for patients with end stage liver disease in British Columbia (13.61, 11.94 to 15.49; P<0.001). In regression analyses, older age, recent substance misuse, alcohol misuse, and comorbidities were associated with higher mortality rates.
Conclusion Mortality rates among people successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals are high compared with the general population. Drug and liver related causes of death were the main drivers of excess mortality. These findings highlight the need for continued support and follow-up after successful treatment for hepatitis C to maximise the impact of direct acting antivirals.
Journal Article Type | Article |
---|---|
Acceptance Date | Jun 26, 2023 |
Online Publication Date | Aug 2, 2023 |
Publication Date | Aug 2, 2023 |
Deposit Date | Aug 10, 2023 |
Publicly Available Date | Aug 15, 2023 |
Journal | BMJ |
Publisher | BMJ |
Peer Reviewed | Peer Reviewed |
Volume | 382 |
Article Number | e074001 |
DOI | https://doi.org/10.1136/bmj-2022-074001 |
Keywords | General Earth and Planetary Sciences; General Environmental Science |
Public URL | https://nottingham-repository.worktribe.com/output/23861252 |
Publisher URL | https://www.bmj.com/content/382/bmj-2022-074001 |
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Mortality rates among patients successfully treated for hepatitis C in the era of interferon-free antivirals: population based cohort study
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This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.
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