PIN101 ALL-ORAL DIRECT-ACTING ANTIVIRALS DECREASE LIVER COMPLICATIONS IN CHRONIC HEPATITIS C PATIENTS WITH SUBSTANCE USE DISORDERS IN THE UNITED STATES

Abstract

To determine whether the impact of all-oral direct-acting antivirals (DAAs) on the incidence of liver complications (decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC)) is moderated by the status of substance use disorders (SUDs) among patients who chronically infected with hepatitis C virus (HCV). A retrospective cohort analysis of the Truven database (January 2013-December 2017) was conducted for newly diagnosed HCV patients. Liver complication was defined as the first occurrence of DCC or HCC. A multivariable Cox proportional hazards regression model was used to compare the risk of developing liver complications, among four groups based on SUD status and receipt of DAAs. Outcome was stratified by presence of cirrhosis. In a cohort of 28,092 HCV patients, 21% had SUD and 35% received DAAs. The crude incidence rate of liver complications in the untreated patients with and without SUD was 24 and 19 per 1000 person-years whereas that was 16 and 13 per 1000 person-years for the treated patients with and without SUD, respectively. In Cox models, among noncirrhotic patients (n=27,899), compared to untreated patients without SUD (reference group), untreated group with SUD had a 47% increased risk of developing liver complications (HR:1.47; 95%CI:1.10-1.96). However, once they were treated with DAAs, regardless with SUD (HR:0.87; 95% CI:0.52-1.44) or without SUD (HR: 0.67; 95%CI:0.52-0.87), the risk of liver complications decreased significantly. Similar trend was observed in cirrhotic patients (n=2,428). Compared to reference group, DAA treated patients with and without SUD had a 55% and a 49% decreased risk of developing liver complications (HR:0.45; 95%CI:0.25-0.82; HR:0.51; 95%CI:0.37-0.72), but there was no significant difference between untreated cirrhotic patients. DAA therapy was associated with a significant decreased risk of liver complications regardless of SUD status. However, among non-cirrhotic HCV patients, untreated patients with a SUD had significantly higher risk of liver complications compared to those without SUD.