Effects on health-related quality of life of interferon-free antiviral therapy for chronic hepatitis C infection – Results from the German Hepatitis C-Registry (DHC-R)

Background and aims:

Only limited data are available, regarding the influence of IFN-free, DAA-mediated therapy on patient reported outcomes (PROs) and clinical symptoms in patients with chronic hepatitis C infection. Therefore, we longitudinally assessed Short-Form 36 (SF-36) scores in HCV patients antivirally treated in a real world setting and focused on the identification of subgroups especially profiting from DAA regimens with respect to self-reported quality of life (QoL).

Method:

The DHC-R (German Hepatitis C-Registry) is a national real-world cohort including about 15,500 patients recruited by more than 250 centers. We evaluated the influence of DAA medication on the time course of PROs (SF-36) at the end of treatment (EOT) and at follow-up 12 to 24 weeks after EOT (FU12/24) compared to baseline (BL) levels. Potential predictors of QoL improvement were identified using multivariate linear regression (predictor candidates: age, comorbidities, use of ribavirin (RBV), pre-treatment status, aminotransferases, BL SF-36 scores).

Results:

A total of 1.180 patients with complete PRO-data were considered (684 males, 496 females, mean age 53.4 years). SF-36 physical (PCS) (P < 0.001) and mental component summary scale (MCS) (P < 0.001) increased significantly at EOT and FU12/24 when compared to BL levels. These increases were associated with SF-36 BL levels (BL PCS < 50: P < 0.001; BL mental summary score < 43: P = 0.022). Other potential factors were not relevant in this context. Further sub-analyses demonstrated that the increase in the SF-36 subscale “social functioning” was associated with the absence of HIV infection (P = 0.045) and the absence of RBV containing treatment (P = 0.002). Despite the overall improvement, worsening in SF-36 PCS was reported for 43.6 (EOT) and 38.0% (FU12/24) of the patients when compared to SF-36 BL level. SF-36 MCS worsened in 41.7 (EOT) and 31.9% (FU12/24) of the patients.

Conclusion:

HCV patients undergoing DAA-based antiviral treatment significantly improve their self-reported QoL. The improvement in terms of increase in SF-36 scores is best predicted by BL levels of QoL. However, more than one third of patients do not improve in PCS and MCS. Longer follow-up is required to determine the extent of improvement in QoL after HCV clearance.