Risk of Cardiovascular and Cerebrovascular Events in Hepatitis C Patients Following Completion of Direct-Acting Antiviral Therapy: A Retrospective Cohort Study = Risk of Cardiovascular and Cerebrovascular Events in Hepatitis C Patients Following Completion of Direct-Acting Antiviral Therapy: A Retrospective Cohort Study

다국어 초록 (Multilingual Abstract)

Aims: Chronic hepatitis C virus (HCV) infection has been associated with adverse cardiovascular and cerebrovascular outcomes. Viral eradication with direct-acting antiviral (DAA) therapy may decrease the risk of these events among HCV patients. We aimed to characterize the risk of cardiovascular and cerebrovascular events among HCV patients treated with DAA regimens compared to untreated patients in US claims data.
Methods: 322,276 adults with chronic HCV were enrolled in the database between January 2006 and September 2015. We identified 8,342 HCV patients dispensed at least 12 weeks of DAA therapy (excluding boceprevir and telaprevir) and, for comparison, 76,423 untreated HCV patients who had follow-up time in the DAA era. Events were identified by diagnostic claims for acute and chronic ischemic heart disease, angina pectoris, cardiomyopathy, heart failure, subarachnoid hemorrhage, occlusion and stenosis of precerebral or cerebral arteries, cerebrovascular disease, cerebral atherosclerosis, intracerebral hemorrhage, and transient cerebral ischemia. Hazard ratios (HRs) estimating risk of incident cardiovascular and cerebrovascular events associated with completion of DAA therapy were calculated with adjustment for covariates using Cox proportional hazards methods.
Results: HCV patients dispensed a full course of DAA therapy were more likely to be male, over 55 years-old, with baseline diagnoses of cirrhosis, diabetes, or hypertension, and on cardiovascular medications. After adjustment for covariates, there was a reduced risk of total cardiovascular and cerebrovascular events in patients completing DAA therapy compared to untreated patients (HR=0.86, 95% confidence interval [CI]: 0.74-0.99). Adjusted HRs were similar for cardiovascular disease (HR=0.90, 95%CI: 0.76-1.05) and cerebrovascular disease (HR=0.89, 95%CI: 0.74-1.08).
Conclusions: In this real-world cohort, DAA therapy appeared to reduce the risk of cardiovascular and cerebrovascular events in HCV patients even within a short period following therapy. The benefits of curative DAA therapy in reducing extrahepatic complications of HCV may be even greater with longer follow-up.