In:
American Journal of Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 116, No. 3 ( 2021-03), p. 576-583
Abstract:
Despite recognized differences in the rates of cardiovascular and renal disease between men and women in the general population, studies of the downstream effects of antiviral treatment for hepatitis C (HCV) have not investigated differences in outcomes based on sex. We analyzed sex differences in risk of acute coronary syndrome (ACS), end-stage renal disease (ESRD), and ischemic stroke by treatment and response in a large US-based multisite cohort of HCV patients. METHODS: Observation started at the HCV diagnosis date (untreated) or last antiviral treatment start (treated). Treatment selection bias was addressed using an inverse probability-weighting approach. We estimated the effect of treatment on the cumulative incidence of outcomes using the Fine-Gray method (subdistribution hazard ratios [sHR] and 95% confidence intervals [95% CI] ). Death was a competing risk. RESULTS: Roughly 40% of 15,295 HCV patients were women. After controlling for other risk factors, sustained virological response (SVR) (interferon-based [IFN] or direct-acting antiviral [DAA] ) significantly reduced risk of all outcomes, particularly among female patients. Female patients who achieved SVR after IFN-based treatment had significantly lower risk of ACS compared with male patients with SVR from either treatment type (sHR 0.45 [95% CI 0.35–0.59] vs 0.81 [95% CI 0.69–0.96, for DAA SVR] and sHR 0.72 [95% 0.62, 0.85, for IFN SVR] ). Successful treatment seemed to be most protective against ESRD; female patients who achieved SVR were at 66%–68% lower risk than untreated patients (sHR 0.32 [95% CI 0.17–0.60 for DAA SVR] and 0.34 [95% CI 0.20–0.58 for IFN SVR] ), whereas men were at 38%–42% lower risk (sHR 0.62 [95% CI 0.46–0.85 for DAA SVR] and 0.58 [95% CI 0.43–0.76 for IFN SVR] ). IFN treatment failure significantly increased risk of all outcomes by 50%–100% among female patients. Compared with no treatment, female patients who experienced IFN treatment failure were at 63% increased risk of ACS (sHR 1.63 [95% CI 1.35–1.96]), almost twice the risk of ESRD (sHR 1.95 [95% CI 1.43–2.66] ) and 51% increased risk of stroke (sHR 1.49 [95%CI 1.11–2.00]). DISCUSSION: SVR reduced the risk of extrahepatic complications, particularly in females. The significantly increased risk associated with IFN TF in women—a subset who represented roughly 10% of that group—underscores the importance of prioritizing these patients for DAA treatment irrespective of the fibrosis stage.
Type of Medium:
Online Resource
ISSN:
0002-9270
,
1572-0241
DOI:
10.14309/ajg.0000000000001095
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
