Sustained responders have lower rates of liver-related events and a better quality of life and productivity compared with non-responders/relapsers after antiviral treatment of chronic hepatitis C

Background: Limited data exist regarding liver-related morbidity and health-related quality of life after treatment of chronic HCV infection with interferon (IFN)-based therapies in the real-life setting. We therefore conducted a non-interventional follow-up survey in German gastroenterological practices to compare long-term clinical outcome in patients who achieved sustained virologic response (SVR) or non-SVR after IFN-based HCV treatment.

Methods: Patients with chronic hepatitis C who achieved SVR/Non-SVR after IFN-based treatment >3 years ago and who are still under routine medical observation were enrolled by 45 gastroenterological centers in Germany. Significant clinical events related to progression of liver disease (ascites, variceal bleeding, hepatic malignancy and liver transplantation) were recorded. Health-related quality of life (HRQOL) was assessed by the SF-36 questionnaire.

Results: From May 2009 until October 2010 N=1355 patients (male 58.0%, mean age 49.2 +/-11.48yrs) infected with G1 (62.4%), G2 (8.1%), G3 (26.3%) and G4/other (3.2%) have been enrolled. Median follow up was 4yrs (range 3 to 8yrs). 42 and 1313 pts were treated with non-pegylated/pegylated IFN in combination with ribavirin. In total 759/1355 (56%) achieved SVR after first therapy. Only 3 SVR patients (0.4%) developed a liver-related clinical event in contrast to 31 (6.2%) non-SVR patients. Of the 34 pts patients who had significant liver-related clinical events, 24 (including the 3 pts with SVR) had baseline cirrhosis. Non-SVR patients had significantly lower scores on the eight SF-36 domains (each P<0.0001) indicating lower HRQOL. In addition, non-SVR patients were more likely to have a lower productivity as assessed by a lower frequency of employment (41% vs. 56%, P<0.0001), a lower number of working hours/week (27 vs. 32, P=0.0031) and a higher number of outpatient (9.4 vs. 5.3, P<0.0001) as well as inpatient visits (0.9 vs. 0.1, P=0.0013) after HCV treatment. Regarding HRQOL and productivity, similar and significant differences were obtained following stratification by gender, age (<50 years/>50 years), type of non-SVR (non-response/relapse) and number of antiviral treatments (1/>1).

Conclusions: SVR has a profound impact on liver related morbidity suggesting a clinical and not only virological cure of chronic hepatitis C. In addition, SVR is associated with a better quality of life and productivity. Altogether our results demonstrate the beneficial effect of successful HCV treatment in a large real-world population.