Sustained virological response to hepatitis C treatment decreases the incidence of complications associated with type 2 diabetes
| Autor: | Jia, Li, Stuart C, Gordon, Loralee B, Rupp, Talan, Zhang, Sheri, Trudeau, Scott D, Holmberg, Anne C, Moorman, Philip R, Spradling, Eyasu H, Teshale, Joseph A, Boscarino, Mark A, Schmidt, Yihe G, Daida, Mei, Lu, Judy L, Donald |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Acute coronary syndrome medicine.medical_specialty Sustained Virologic Response Type 2 diabetes Hepacivirus Antiviral Agents Article Cohort Studies Diabetes Complications 03 medical and health sciences 0302 clinical medicine Internal medicine Diabetes mellitus medicine Humans Pharmacology (medical) 030212 general & internal medicine Prospective Studies Prospective cohort study Stroke Aged Retrospective Studies Hepatology business.industry Incidence Gastroenterology Type 2 Diabetes Mellitus Hepatitis C Middle Aged Hepatitis C Chronic medicine.disease Treatment Outcome Diabetes Mellitus Type 2 030211 gastroenterology & hepatology Female Interferons business Retinopathy |
| Popis: | SUMMARY: BACKGROUND: The role of hepatitis C (HCV) eradication on the long-term complications of type 2 diabetes mellitus remains incompletely studied. AIM: To investigate whether antiviral treatment impacted risk of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy among diabetic patients from the four US health systems comprising the Chronic Hepatitis Cohort Study (CHeCS). METHODS: We included CHeCS HCV patients with diagnosis codes for type 2 diabetes who were on antidiabetic medications. Patients were followed until an out-come of interest, death, or last health system encounter. The effect of treatment on outcomes was estimated using the competing risk analysis (Fine-Gray subdistribution hazard ratio [sHR]), with death as a competing event. RESULTS: Among 1395 HCV-infected patients with type 2 diabetes, 723 (52%) were treated with either interferon-based or direct-acting antivirals (DAAs); 539 (75% of treated) achieved sustained virological response (SVR). After propensity score adjustment to address treatment selection bias, patients with SVR demonstrated significantly decreased risk of acute coronary syndrome (sHR = 0.36; P < 0.001), end-stage renal disease (sHR = 0.46; P < 0.001), stroke (sHR = 0.34; P < 0.001), and retinopathy (sHR = 0.24; P < 0.001) compared to untreated patients. Results were consistent in subgroup analyses of DAA-treated patients and interferon-treated patients, an analysis of cirrhotic patients, as well as in sensitivity analyses considering cause-specific hazards, exclusion of patients with on-treatment retinopathy, and treatment status as a time-varying covariate. CONCLUSION: Successful HCV treatment among patients with type 2 diabetes significantly reduces incidence of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy, regardless of cirrhosis. Our findings support the importance of HCV antiviral therapy among patients with type 2 diabetes to reduce the risk of these extrahepatic outcomes. |
| Databáze: | OpenAIRE |
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