Butt AA, et al. - This study was planned to quantify the effect of paritaprevir/ritonavir, ombitasvir, dasabuvir (PrOD) and ledipasvir/sofosbuvir (LDV/SOF) regimens upon mortality compared with untreated hepatitis C virus (HCV) –infected persons. Treatment with PrOD or LDV/SOF and sustained virologic response (SVR) seemed associated with a significant mortality benefit, apparent within the first 18 months of treatment.

Methods

• Researchers identified HCV-infected persons initiated on PrOD or LDV/SOF in the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), a well-established national cohort of HCV-infected Veterans.
• They excluded patients with human immunodeficiency virus, hepatitis B surface antigen positivity, hepatocellular carcinoma, or missing HCV RNA or FIB-4 scores.
• For each case, a propensity score–matched control never initiated on treatment was identified.
• Survival was primarily assessed.
• They used frequency of events, Kaplan-Meier curves, and Cox proportional hazards regression analyses to assess the outcomes.

Results

• Researchers identified 1473 persons on PrOD, 5497 on LDV/SOF, and 6970 propensity score–matched untreated persons.
• Obesity and cirrhosis were more prevalent in treated persons, but these patients less frequently presented stage 3–5 chronic kidney disease (CKD), alcohol or drug abuse or dependence diagnosis, and anemia.
• In the untreated group, higher proportion of persons died compared with either treatment group (PrOD, 0.3%; LDV/SOF, 1.4%; untreated controls, 2.5%; P < .001).
• There were significantly larger percentage of treated patients who survived to 18 months of follow-up, compared with untreated controls (P < .001).
• Multivariable Cox regression analysis suggested that treatment with either regimen (hazard ratio [HR], 0.43; 95% confidence interval [CI], .33–.57) and attainment of sustained virologic response (SVR) were associated with significantly lower mortality (HR, 0.57; 95% CI, .33–.99).