Jia Li1, Stuart C Gordon2, Loralee B Rupp3, Talan Zhang1, Sheri Trudeau1, Scott D Holmberg4, Anne C Moorman4, Philip R Spradling4, Eyasu H Teshale4, Joseph A Boscarino5, Mark A Schmidt6, Yihe G Daida7, Mei Lu1. 1. Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan. 2. Division of Gastroenterology and Hepatology, Henry Ford Health System, and Wayne State University School of Medicine, Detroit, Michigan. 3. Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. 4. Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. 5. Department of Epidemiology & Health Services Research, Geisinger Clinic, Danville, Pennsylvania. 6. Center for Health Research, Kaiser Permanente-Northwest, Portland, Oregon. 7. Center for Health Research, Kaiser Permanente-Hawai'i, Honolulu, Hawaii.
Abstract
BACKGROUND: The role of hepatitis C (HCV) eradication on the long-term complications of type 2 diabetes mellitus remains incompletely studied. AIM: To investigate whether antiviral treatment impacted risk of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy among diabetic patients from the four US health systems comprising the Chronic Hepatitis Cohort Study (CHeCS). METHODS: We included CHeCS HCV patients with diagnosis codes for type 2 diabetes who were on antidiabetic medications. Patients were followed until an outcome of interest, death, or last health system encounter. The effect of treatment on outcomes was estimated using the competing risk analysis (Fine-Gray subdistribution hazard ratio [sHR]), with death as a competing event. RESULTS: Among 1395 HCV-infected patients with type 2 diabetes, 723 (52%) were treated with either interferon-based or direct-acting antivirals (DAAs); 539 (75% of treated) achieved sustained virological response (SVR). After propensity score adjustment to address treatment selection bias, patients with SVR demonstrated significantly decreased risk of acute coronary syndrome (sHR = 0.36; P < 0.001), end-stage renal disease (sHR = 0.46; P < 0.001), stroke (sHR = 0.34; P < 0.001), and retinopathy (sHR = 0.24; P < 0.001) compared to untreated patients. Results were consistent in subgroup analyses of DAA-treated patients and interferon-treated patients, an analysis of cirrhotic patients, as well as in sensitivity analyses considering cause-specific hazards, exclusion of patients with on-treatment retinopathy, and treatment status as a time-varying covariate. CONCLUSION: Successful HCV treatment among patients with type 2 diabetes significantly reduces incidence of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy, regardless of cirrhosis. Our findings support the importance of HCV antiviral therapy among patients with type 2 diabetes to reduce the risk of these extrahepatic outcomes.
BACKGROUND: The role of hepatitis C (HCV) eradication on the long-term complications of type 2 diabetes mellitus remains incompletely studied. AIM: To investigate whether antiviral treatment impacted risk of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy among diabeticpatients from the four US health systems comprising the Chronic Hepatitis Cohort Study (CHeCS). METHODS: We included CHeCS HCVpatients with diagnosis codes for type 2 diabetes who were on antidiabetic medications. Patients were followed until an outcome of interest, death, or last health system encounter. The effect of treatment on outcomes was estimated using the competing risk analysis (Fine-Gray subdistribution hazard ratio [sHR]), with death as a competing event. RESULTS: Among 1395 HCV-infectedpatients with type 2 diabetes, 723 (52%) were treated with either interferon-based or direct-acting antivirals (DAAs); 539 (75% of treated) achieved sustained virological response (SVR). After propensity score adjustment to address treatment selection bias, patients with SVR demonstrated significantly decreased risk of acute coronary syndrome (sHR = 0.36; P < 0.001), end-stage renal disease (sHR = 0.46; P < 0.001), stroke (sHR = 0.34; P < 0.001), and retinopathy (sHR = 0.24; P < 0.001) compared to untreated patients. Results were consistent in subgroup analyses of DAA-treated patients and interferon-treated patients, an analysis of cirrhotic patients, as well as in sensitivity analyses considering cause-specific hazards, exclusion of patients with on-treatment retinopathy, and treatment status as a time-varying covariate. CONCLUSION: Successful HCV treatment among patients with type 2 diabetes significantly reduces incidence of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy, regardless of cirrhosis. Our findings support the importance of HCV antiviral therapy among patients with type 2 diabetes to reduce the risk of these extrahepatic outcomes.
Authors: M Alan Brookhart; Sebastian Schneeweiss; Kenneth J Rothman; Robert J Glynn; Jerry Avorn; Til Stürmer Journal: Am J Epidemiol Date: 2006-04-19 Impact factor: 4.897
Authors: Richard K Sterling; Eduardo Lissen; Nathan Clumeck; Ricard Sola; Mendes Cassia Correa; Julio Montaner; Mark S Sulkowski; Francesca J Torriani; Doug T Dieterich; David L Thomas; Diethelm Messinger; Mark Nelson Journal: Hepatology Date: 2006-06 Impact factor: 17.425
Authors: M Sanni Ali; Rolf H H Groenwold; Svetlana V Belitser; Wiebe R Pestman; Arno W Hoes; Kit C B Roes; Anthonius de Boer; Olaf H Klungel Journal: J Clin Epidemiol Date: 2014-11-26 Impact factor: 6.437
Authors: J Li; S C Gordon; L B Rupp; T Zhang; J A Boscarino; V Vijayadeva; M A Schmidt; M Lu Journal: J Viral Hepat Date: 2014-01-29 Impact factor: 3.728
Authors: David Jones; Pol F Boudes; Mark G Swain; Christopher L Bowlus; Michael R Galambos; Bruce R Bacon; Yvonne Doerffel; Norman Gitlin; Stuart C Gordon; Joseph A Odin; David Sheridan; Markus-Alexander Wörns; Virginia Clark; Linsey Corless; Heinz Hartmann; Mark E Jonas; Andreas E Kremer; George F Mells; Peter Buggisch; Bradley L Freilich; Cynthia Levy; John M Vierling; David E Bernstein; Marek Hartleb; Ewa Janczewska; Fedja Rochling; Hemant Shah; Mitchell L Shiffman; John H Smith; Yun-Jung Choi; Alexandra Steinberg; Monika Varga; Harinder Chera; Robert Martin; Charles A McWherter; Gideon M Hirschfield Journal: Lancet Gastroenterol Hepatol Date: 2017-08-14
Authors: Mei Lu; Wadih Chacra; David Rabin; Loralee B Rupp; Sheri Trudeau; Jia Li; Stuart C Gordon Journal: Clin Epidemiol Date: 2017-07-12 Impact factor: 4.790
Authors: Hashem B El-Serag; Israel C Christie; Amy Puenpatom; Diana Castillo; Fasiha Kanwal; Jennifer R Kramer Journal: Aliment Pharmacol Ther Date: 2019-04-01 Impact factor: 8.171
Authors: Arun Rajasekaran; Ricardo A Franco; Edgar T Overton; Brendan M McGuire; Graham C Towns; Jayme E Locke; Deirdre L Sawinski; Emmy K Bell Journal: Kidney Int Rep Date: 2021-04-25