Direct-acting antiviral (DAA) therapy is a safe and effective treatment that provides hepatologic and rheumatologic benefits for patients with concomitant hepatitis C virus (HCV) infection and rheumatic diseases, according to study results published in Modern Rheumatology.

Infection with HCV in patients with autoimmune rheumatic diseases is associated with many clinical symptoms, including hepatotoxicity from antirheumatic drugs and immunosuppressants. DAA therapy has recently been approved for HCV treatment; however, there has been no solid data to confirm whether DAA therapy is effective or beneficial in patients with rheumatic disease receiving immunosuppressive treatment.

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The objective of this study was to assess the efficacy and safety of DAA therapy for patients with concomitant HCV infection and rheumatic diseases.

In a single-center, observational, case-series study, researchers reviewed retrospective data for 2314 patients with concomitant HCV infection and rheumatic diseases who were treated in the rheumatology department at University Hospital, Kyoto Prefectural University of Medicine in Japan between 2014 and 2018. Clinical data including age, sex, and medication history were recorded at baseline when DAA therapy was initiated, at 8 weeks, at the end of therapy, and 24 weeks after therapy ended. 

The primary end point was the sustained virological response (SVR) rate at 24 weeks after therapy. Secondary end points assessed during and after DAA therapy included changes in serum HCV-RNA, alanine aminotransferase, Child-Pugh score, and the fibrosis-4 index for estimating hepatologic disease severity; progression rates of cirrhosis and hepatocellular carcinoma; changes in rheumatic diseases  treatment and disease activity; and any adverse events.

Of the 2314 patients in this study, 18 received DAA therapy of whom11 had rheumatoid arthritis and 7 had other rheumatic diseases. The SVR rate for the initial DAA therapy was 89% (n=16); the remaining 2 patients achieved SVR with secondary DAA therapy. Hepatologic parameters also improved significantly from baseline to 24 weeks following DAA therapy.

There were no new cases of cirrhosis or hepatocellular carcinoma after HCV elimination during the study period. The simplified disease activity index decreased significantly from 11.53 (interquartile range [IQ], 5.14-14.89) at baseline to 4.06 (IQ, 2.08-9.05) at 24 weeks after DAA therapy. Adverse events from treatment were minimal; however, 2 patients experienced tuberculosis reactivation after DAA therapy ended.

There were 4 study limitations. First, the cohort was small and a larger cohort may be needed to determine whether findings can be generalized. Second, immunoglobulin G and rheumatoid factor data were missing for several patients, preventing further analysis of immunologic parameters. Third, hepatologic and rheumatologic outcomes and adverse events in patients receiving DAA therapy were not compared with untreated patients with similar backgrounds. Finally, further studies may be needed to prospectively accumulate clinical and immunologic data while taking the “Weber effect” into consideration.

“Attention should be paid to immune reconstitution following HCV elimination in each patient, which can influence reactivation of latent infections,” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Kida T, Umemura A, Kaneshita S, et al. Effectiveness and safety of chronic hepatitis C treatment with direct-acting antivirals in patients with rheumatic diseases: a case-series [published online October 18, 2019]. Mod Rheumatol. doi:10.1080/14397595.2019.1682787