Savino Bruno1, Vito Di Marco2, Massimo Iavarone3, Luigi Roffi4, Andrea Crosignani5, Vincenza Calvaruso2, Alessio Aghemo3, Giuseppe Cabibbo2, Mauro Viganò3, Vincenzo Boccaccio6, Antonio Craxí2, Massimo Colombo3, Patrick Maisonneuve7. 1. Humanitas University and IRCCS Istituto Clinico Humanitas, Rozzano, Italy. Electronic address: savino.bruno@hunimed.eu. 2. Sezione di Gastroenterologia e Epatologia, DIBIMIS, Università degli Studi di Palermo, Palermo, Italy. 3. UO Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi di Milano, Milan, Italy. 4. Dipartimento di Medicina, A.O. Istituti Clinici di Perfezionamento, Milan, Italy. 5. Dipartimento di Medicina Interna, A.O. San Paolo, Milan, Italy. 6. Humanitas University and IRCCS Istituto Clinico Humanitas, Rozzano, Italy. 7. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
Abstract
BACKGROUND & AIMS: Life expectancy of patients with compensated hepatitis C virus (HCV) cirrhosis achieving sustained virologic response (SVR) is limited by liver events as compared to the general population. Thus, survival benefit of SVR remains to be measured. METHODS: The study includes prospective surveillance data from three cohorts of Italian patients with compensated HCV cirrhosis who achieved SVR on an interferon-based (IFN) regimen, compared to simultaneously observed non-SVR, untreated and decompensated patients. Overall survival was calculated from the date of start of IFN to death. The number of deaths expected during the at-risk period was determined by applying age- and sex-specific mortality rates recorded in Italy for person-years adequate for the enrolment period. The standardized mortality ratio (SMR) determined the relative risk of death over that of the age and sex matched general population. RESULTS: Overall, 28/181 patients followed-up for a median period of 9.6years (range 1-25years) died. The 10 and 20-year overall survival rates for the whole series were 90.9% (95% CI, 84.3-94.8) and 62.9% (95% CI, 45.9-75.9), respectively. The number of expected deaths in the corresponding age and sex matched general population was 28.1, corresponding to a SMR=1.00 (95% CI, 0.72-1.35), with an SMR for non-SVR patients of 3.85 (95% CI, 3.43-4.30), for untreated of 3.01 (95% CI, 2.64-3.42) and for decompensated of 6.70 (95% CI, 5.39-8.22). CONCLUSIONS: Patients with compensated HCV cirrhosis achieving SVR by IFN obtain a main benefit levelling their survival curve to that of the general population. Wider applicability of IFN-free regimens will possibly make this achievement more generalizable.
BACKGROUND & AIMS: Life expectancy of patients with compensated hepatitis C virus (HCV) cirrhosis achieving sustained virologic response (SVR) is limited by liver events as compared to the general population. Thus, survival benefit of SVR remains to be measured. METHODS: The study includes prospective surveillance data from three cohorts of Italian patients with compensated HCV cirrhosis who achieved SVR on an interferon-based (IFN) regimen, compared to simultaneously observed non-SVR, untreated and decompensated patients. Overall survival was calculated from the date of start of IFN to death. The number of deaths expected during the at-risk period was determined by applying age- and sex-specific mortality rates recorded in Italy for person-years adequate for the enrolment period. The standardized mortality ratio (SMR) determined the relative risk of death over that of the age and sex matched general population. RESULTS: Overall, 28/181 patients followed-up for a median period of 9.6years (range 1-25years) died. The 10 and 20-year overall survival rates for the whole series were 90.9% (95% CI, 84.3-94.8) and 62.9% (95% CI, 45.9-75.9), respectively. The number of expected deaths in the corresponding age and sex matched general population was 28.1, corresponding to a SMR=1.00 (95% CI, 0.72-1.35), with an SMR for non-SVR patients of 3.85 (95% CI, 3.43-4.30), for untreated of 3.01 (95% CI, 2.64-3.42) and for decompensated of 6.70 (95% CI, 5.39-8.22). CONCLUSIONS:Patients with compensated HCV cirrhosis achieving SVR by IFN obtain a main benefit levelling their survival curve to that of the general population. Wider applicability of IFN-free regimens will possibly make this achievement more generalizable.
Authors: James Salazar; Varun Saxena; James G Kahn; John P Roberts; Neil Mehta; Michael Volk; Jennifer C Lai Journal: Transplantation Date: 2017-05 Impact factor: 4.939
Authors: Brigg Reilley; Jessica Leston; Mona Doshani; Dana L Haberling; Marissa Person; Thomas Weiser; Melissa Collier; Jonathan Iralu; Jorge Mera; Rick Haverkate Journal: J Community Health Date: 2018-12
Authors: Francesca Romana Ponziani; Francesca Mangiola; Cecilia Binda; Maria Assunta Zocco; Massimo Siciliano; Antonio Grieco; Gian Lodovico Rapaccini; Maurizio Pompili; Antonio Gasbarrini Journal: World J Hepatol Date: 2017-03-08