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Hepatitis C eradication with direct-acting anti-virals reduces the risk of variceal bleeding
- Source :
- Aliment Pharmacol Ther
- Publication Year :
- 2019
-
Abstract
- Background The real-world, long-term benefits of sustained virologic response (SVR) on the risk of variceal bleeding remain unclear. Aim To assess the association between DAA-induced SVR and post-treatment variceal bleeding METHODS: We identified patients who initiated DAA-only anti-viral treatments in the United States Veterans Affairs healthcare system from 2013 to 2015. We followed patients until 1 January 2019 for the development of gastro-oesophageal variceal bleeding defined by diagnostic codes. We used multivariable Cox proportional hazards regression to assess the association between SVR and development of variceal bleeding, adjusting for potential confounders. Results Among 33 582 DAA-treated patients, 549 (1.6%) developed variceal bleeding after treatment (mean follow-up 3.1 years). Compared to no SVR, SVR was associated with a significantly lower incidence of variceal bleeding among all patients (0.46 vs 1.26 per 100 patient-years, adjusted hazard ratio [AHR] 0.66, 95% CI 0.52-0.83), among patients with pre-treatment cirrhosis (1.55 vs 2.96 per 100 patient-years, AHR 0.73, 95% CI 0.57-0.93) and among patients without pre-treatment cirrhosis (0.07 vs 0.29 per 100 patient-years, AHR 0.33, 95% CI 0.17-0.65). The risk of variceal bleeding after treatment was lower in those who achieved SVR vs no SVR among patients who had non-bleeding varices (3.5 vs 4.9 per 100 patient-years) or bleeding varices (12.9 vs 16.4 per 100 patient-years) diagnosed before treatment, but these differences were not statistically significant in adjusted analyses. Conclusion DAA-induced SVR is independently associated with a lower risk of variceal bleeding during long-term follow-up in patients with and without pre-treatment cirrhosis. These findings demonstrate an important real-world benefit of DAA treatment.
- Subjects :
- Adult
Liver Cirrhosis
Male
medicine.medical_specialty
Cirrhosis
Sustained Virologic Response
Lower risk
Esophageal and Gastric Varices
Gastroenterology
Antiviral Agents
Article
Varicose Veins
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
Pharmacology (medical)
030212 general & internal medicine
Veterans Affairs
Aged
Veterans
Hepatology
business.industry
Incidence (epidemiology)
Incidence
Confounding
Hazard ratio
Remission Induction
Hepatitis C
Hepatitis C, Chronic
Middle Aged
medicine.disease
United States
030211 gastroenterology & hepatology
Female
Varices
business
Gastrointestinal Hemorrhage
Follow-Up Studies
Subjects
Details
- ISSN :
- 13652036
- Volume :
- 51
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Alimentary pharmacologytherapeutics
- Accession number :
- edsair.doi.dedup.....976d952f3683a1788bc4b1ddd31e66f4