Improved Survival Among all Interferon-α-Treated Patients in HCV-002, a Veterans Affairs Hepatitis C Cohort of 2211 Patients, Despite Increased Cirrhosis Among Nonresponders

Myrna L Cozen; Warren N Schmidt; James C Ryan; Hui Shen; Ramsey Cheung; David E Kaplan; Christine Pocha; Norbert Brau; Ayse Aytaman; Marcos Pedrosa; Bhupinderjit S Anand; Kyong-Mi Chang; Timothy Morgan; Alexander Monto

doi:10.1007/s10620-016-4122-5

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Improved Survival Among all Interferon-α-Treated Patients in HCV-002, a Veterans Affairs Hepatitis C Cohort of 2211 Patients, Despite Increased Cirrhosis Among Nonresponders

Journal article

Peer reviewed

Improved Survival Among all Interferon-α-Treated Patients in HCV-002, a Veterans Affairs Hepatitis C Cohort of 2211 Patients, Despite Increased Cirrhosis Among Nonresponders

Myrna L Cozen, Warren N Schmidt, James C Ryan, Hui Shen, Ramsey Cheung, David E Kaplan, Christine Pocha, Norbert Brau, Ayse Aytaman, Marcos Pedrosa, …

Digestive diseases and sciences, Vol.61(6), pp.1744-1756

06/2016

DOI: 10.1007/s10620-016-4122-5

PMCID: PMC5308124

PMID: 27059981

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https://www.ncbi.nlm.nih.gov/pmc/articles/5308124View

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Abstract

As the era of interferon-alpha (IFN)-based therapy for hepatitis C ends, long-term treatment outcomes are now being evaluated. To more fully understand the natural history of hepatitis C infection by following a multisite cohort of patients. Patients with chronic HCV were prospectively enrolled in 1999-2000 from 11 VA medical centers and followed through retrospective medical record review. A total of 2211 patients were followed for an average of 8.5 years after enrollment. Thirty-one percent of patients received HCV antiviral therapy, 15 % with standard IFN/ribavirin only, 16 % with pegylated IFN/ribavirin, and 26.7 % of treated patients achieved sustained virologic response (SVR). Cirrhosis developed in 25.8 % of patients. Treatment nonresponders had a greater than twofold increase in the hazard of cirrhosis and hepatocellular carcinoma, compared to untreated patients, whereas SVR patients were only marginally protected from cirrhosis. Nearly 6 % developed hepatocellular carcinoma, and 27.1 % died during the follow-up period. Treated patients, regardless of response, had a significant survival benefit compared to untreated patients (HR 0.58, CI 0.46-0.72). Improved survival was also associated with college education, younger age, lower levels of alcohol consumption, and longer duration of medical service follow-up-factors typically associated with treatment eligibility. As more hepatitis C patients are now being assessed for all-oral combination therapy, these results highlight that patient compliance and limiting harmful behaviors contribute a significant proportion of the survival benefit in treated patients and that the long-term clinical benefits of SVR may be less profound than previously reported.

Liver Cirrhosis - etiology

United States - epidemiology

Hepatitis C - drug therapy

Humans

Middle Aged

Ribavirin - therapeutic use

Interferon-alpha - therapeutic use

Proportional Hazards Models

Male

Interferon-alpha - administration & dosage

Hepatitis C - epidemiology

Ribavirin - administration & dosage

Adult

Female

United States Department of Veterans Affairs

Cohort Studies

Details

Title: Subtitle: Improved Survival Among all Interferon-α-Treated Patients in HCV-002, a Veterans Affairs Hepatitis C Cohort of 2211 Patients, Despite Increased Cirrhosis Among Nonresponders
Creators: Myrna L Cozen - San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA
Warren N Schmidt - Iowa City VA Medical Center and the University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52242, USA
James C Ryan - San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA
Hui Shen - San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA
Ramsey Cheung - Palo Alto VA Medical Center and Stanford University, 3801 Miranda Ave, GI/Hepatology #154C, Palo Alto, CA, 94304-1207, USA
David E Kaplan - Philadelphia VA Medical Center and University of Pennsylvania, A212 Medical Research, University and Woodland Ave, Philadelphia, PA, 19104, USA
Christine Pocha - Minneapolis VA Medical Center, 1 Veterans Drive, GI, Minneapolis, MN, 55417, USA
Norbert Brau - Bronx VA Medical Center, 130 W. Kingsbridge Rd, Bronx, NY, 10468, USA
Ayse Aytaman - New York Harbor Brooklyn and Manhattan VA Medical Centers, 800 Poly Pl, Brooklyn, NY, 11209, USA
Marcos Pedrosa - Boston VA Health Care System and AbbVie Pharmaceuticals, 85 E. Concord St. #7700, Boston, MA, 02118, USA
Bhupinderjit S Anand - Houston VA Medical Center and Baylor University, Digestive Disease Section, #111D, 2002 Holcombe Blvd, Houston, TX, 77030-4211, USA
Kyong-Mi Chang - Philadelphia VA Medical Center and University of Pennsylvania, A212 Medical Research, University and Woodland Ave, Philadelphia, PA, 19104, USA
Timothy Morgan - Long Beach VA Medical Center and University of California Irvine, #111G, 5901 E. 7th Street, Long Beach, CA, 90822-5201, USA
Alexander Monto - San Francisco VA Medical Center and University of California San Francisco, 4150 Clement St #111B, San Francisco, CA, 94121, USA. Alexander.Monto@va.gov
Resource Type: Journal article
Publication Details: Digestive diseases and sciences, Vol.61(6), pp.1744-1756
DOI: 10.1007/s10620-016-4122-5
PMID: 27059981
PMCID: PMC5308124
NLM abbreviation: Dig Dis Sci
ISSN: 0163-2116
eISSN: 1573-2568
Grant note: I01 BX000159 / BLRD VA P30 DK026743 / NIDDK NIH HHS
Language: English
Date published: 06/2016
Academic Unit: Gastroenterology and Hepatology; Internal Medicine
Record Identifier: 9984094551202771

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