1081 Direct-Acting Antiviral Therapy Against Hepatitis C in Patients With Liver Cancer: Is It Safe?

Abstract

INTRODUCTION: The effect of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) patients with hepatocellular carcinoma (HCC) has been controversial, as initial studies reported increasing incidence and aggressiveness of HCC post-DAA treatment with more recent literature contradicting this claim. Furthermore, questions remain regarding overall survival in this high risk population after DAA treatment, as previous studies have suffered from small sample sizes of HCC cases. METHODS: Data was obtained from the Medicare database on patients diagnosed with HCV and HCC in 2014, and followed for 3 years. Subjects who received DAA therapy were matched to controls based on age, gender, race, and cirrhosis. Outcomes including HCV-related costs, hospitalizations, and mortality rates were measured. Paired t-test was used for independent variables; logistic regression was used to compare outcomes between groups. RESULTS: 1208 subjects were included in this study. 604 of these had received DAA therapy with HCC and were matched to controls who did not receive DAA therapy with HCC. Baseline characteristics were similar between groups (Table 1). The control group had a total of 445 deaths. Those who received DAA therapy had lower rates of mortality through time, with a total of 94 deaths (see Figure 1 for mortality rates through time). HCV-related hospitalizations for those who received DAA therapy significantly declined through time, with 19.5% requiring hospitalization within the first 6 months and 9.4% at 30 months (P = 0.01), whereas the hospitalization rates for the control group did not significantly change. HCV-related costs (Figure 2) also significantly declined through time for those who received DAA therapy (P = 0.02). The costs for the non-DAA therapy group did not significantly decrease (P = 0.63). CONCLUSION: In this largest study to date of HCV patients with HCC, the group selected to receive DAA treatment fared better in the short and long term than those not selected to receive DAA therapy. Patients who received DAA therapy had a low mortality rate over the 3 years of follow up. DAA therapy in the follow up period did not accelerate mortality from baseline. This data supports the paradigm that treating HCV in the setting of HCC is beneficial and is not detrimental either from a mortality or cost perspective. Further investigation including prospective randomized control studies would be warranted to elucidate these findings.