Quelleestlacontribu/ondestroublesliésàl’alcoolaufardeaudel’hépa/teC?

VincentMalletUniversitéParisDescartes,AP—HP,Inserm,Paris,France

vincent.mallet@aphp.fr

Conflitsd’intérêts

VincentMallethasbeenascien?ficadvisororconsultantforGilead,Abbvie,MSD,Janssen-Cilag,BristolMyersSquibb,andTHEN(Transla?onalHealthEconomicsNetwork),hasreceivedpaymentforlecturesthroughspeakers’bureausforAbbvie,BristolMyersSquibb,Gilead,JJ/Janssen-Cilag,Novar?sandRoche,andownsstocksofLinghasystems.

Universalaccesstotreatmentistheobjec/ve

EASLrecommenda?onsontreatmentofhepa??sC2015.JHepatol.2015;63:199–236

From:Associa?onBetweenSustainedVirologicalResponsetoInterferon-basedtreatmentandAll-CauseMortalityAmongPa?entsWithChronicHepa??sCandAdvancedHepa?cFibrosis

Copyright©2015AmericanMedicalAssocia?on.Allrightsreserved.VanderMeer,AJ,etal.JAMA2012;308:2584–2593.

30

All-cau

seM

ortality

%

ALL-CAUSEMORTALITY

20

10

00 1 2 3 4 5 6 7 8 9 10 Time

P<.001

WithoutSVR

WithSVR

No.atriskWithoutSVRWithSVR

405 393 382 363 344 317 295 250 207 164 135192 181 168 162 155 144 125 88 56 40 28

30

Hepa

tocellu

larC

arcino

ma

%

HEPATOCELLULARCARCINOMA

20

10

00 1 2 3 4 5 6 7 8 9 10 Time

P<.001 WithoutSVR

WithSVR

No.atriskWithoutSVRWithSVR

405 390 375 349 326 294 269 229 191 151 122192 181 167 161 152 142 124 86 54 39 27

30

Liver-relatedMortalityor

LiverT

ransplan

ta/o

n,%

LIVER-RELATEDMORTALITYORLIVERTRANSPLANTATION

20

10

00 1 2 3 4 5 6 7 8 9 10 Time

P<.001

WithoutSVR

WithSVR

No.atriskWithoutSVRWithSVR

405 393 380 358 334 305 277 229 187 146 119192 181 168 162 155 144 125 88 56 40 28

30

LiverF

ailure

%

LIVERFAILURE

20

10

00 1 2 3 4 5 6 7 8 9 10 Time

P<.001 WithoutSVR

WithSVR

No.atriskWithoutSVRWithSVR

405 384 361 337 314 288 259 216 184 143 113192 180 166 160 152 141 123 88 56 40 28

Copyright©2015AmericanMedicalAssocia?on.Allrightsreserved.VanderMeer,AJ,etal.JAMA2014;312:1927–1928.

OverallSurvivalinPa/entsWithChronicHepa//sCVirusInfec/onandAdvancedHepa/cFibrosisWithandWithoutSustainedVirologicalResponse(SVR)toInterferon-basedTreatmentComparedWithanAge-andSex-MatchedGeneralPopula/onTimezerois24weeksfollowingcessa/onofan/viraltherapy,atwhich/meitwasdeterminedwhetherpa/entsadainedSVR.

From:LifeExpectancyinPa?entsWithChronicHCVInfec?onandCirrhosisComparedWithaGeneralPopula?on

100

Cumula/

veOverallSurvival%

PATIENTSWITHSVR

40

20

00 1 2 3 4 5 6 7 8 9 10

Time,y

P=.57

Matchedpopula/on

No.atrisk 192 181 168 162 155 144 125 88 56 40 28

60

80 WithSVR

100

Cumula/

veOverallSurvival%

PATIENTSWITHOUTSVR

40

20

00 1 2 3 4 5 6 7 8 9 10

Time,yNo.atrisk 405 393 382 363 344 317 295 250 207 164 135

60

80

WithoutSVRP<.001

Matchedpopula/on

Hamish Innes, Scott McDonald, Peter Hayes, John F. Dillon, Sam Allen, David Goldberg, Peter R. Mills, Stephen T. Barclay, David Wilks, Heather Valerio, Ray Fox, Diptendu Bhattacharyya, Nicholas Kennedy, Judith Morris, Andrew Fraser, Adrian Stanley, Peter Bramley, Sharon J. Hutchinson

Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population

Journal of Hepatology, 2016, Available online 18 August 2016

http://dx.doi.org/10.1016/j.jhep.2016.08.004

L’expérienceEcossaiseSurmortalitéhépa/que(x6)despa/entsHCVguéris

InnesH,etal.Hepatology2015;62:355–364. Dateofprepara?onApril2016IGBL/VIEX/0416/0488c

Hazardreduc?onassociatedwithSVR(vs.non-SVR),foreachoutcomeevent,accordingtoAPRI.Es?matesareadjustedfordifferencesinbasicdemographics;medicalcomorbidi?es;viralgenotype;

behaviorfactorsandliverfunc?ontests.(N=3385)

InnesH,etal.Hepatology2015;62:355–364.

OUTCOME

Livermortality

Non-livermortality

All-causemortality

Severelivermorbidity

Cardiovasculardisease

Respiratorydiseases

Neoplasms

Alcoholintoxica?on

Drugintoxica?on

Violence-relatedinjury

APRI(inferreddiseasestage)

<0.7(mild)≥0.7(non-mild)

<0.7(mild)≥0.7(non-mild)

<0.7(mild)≥0.7(non-mild)

<0.7(mild)≥0.7(non-mild)

<0.7(mild)≥0.7(non-mild)

<0.7(mild)≥0.7(non-mild)

<0.7(mild)≥0.7(non-mild)

<0.7(mild)≥0.7(non-mild)

<0.7(mild)≥0.7(non-mild)

<0.7(mild)≥0.7(non-mild)

HAZARDRATIO(SVRvsnon-SVR)

0.50(0.15-1.74)0.20(0.10-0.40)

0.85(0.51-1.42)0.55(0.32-0.92)

0.82(0.51-1.30)0.35(0.23-0.52)

0.27(0.04-1.92)0.20(0.12-0.35)

0.91(0.64-1.29)0.61(0.46-0.80)

1.04(0.70-1.56)0.84(0.57-1.25)

1.11(0.63-1.94)0.90(0.56-1.43)

0.74(0.37-1.48)0.40(0.21-0.75)

0.74(0.42-1.28)0.81(0.44-1.50)

0.58(0.31-1.09)0.45(0.23-0.85)

P-VALUEFORSVR*APRIINTERACTIONTERM

0.221

0.263

0.010

0.796

0.083

0.470

0.598

0.214

0.834

0.573

0HazardRa/o .25 .5 .75 1 1.25 1.5 1.75 2

FigureLegend:Prevalenceofan/bodiestohepa//sCvirus(HCV)byagegroup(A)andyearofbirth(B)intheThirdNa/onalHealthandNutri/onExamina/onSurvey(NHANESIII,1988–1994)andthecurrentNHANES(1999–2002).Thever/calbarsrepresent95%CIs.

Copyright©AmericanCollegeofPhysicians.Allrightsreserved.ArmstrongGL,etal.AnnInternMed2006;144:705–714.

From:ThePrevalenceofHepa??sCVirusInfec?onintheUnitedStates,1999through2002

7.0

Prop

or/o

nAn

/-HC

V-Po

si/v

e,%

0

0 10 20 30 40 50 60 70

AgeatTimeofSurvey,y

1988-1994 1999-2002

6.0

5.0

4.0

3.0

2.0

1.0

7.0

Prop

or/o

nAn

/-HC

V-Po

si/v

e,%

0

1910 1920 1930 1940 1950 1960 1970 1990

YearofBirth

1988-1994 1999-2002

6.0

5.0

4.0

3.0

2.0

1.0

1980

Dateofprepara?onApril2016IGBL/VIEX/0416/0488c

LouReed’scaseandcausesofdeathinreal-lifehepCpa?ents

Wemaysoonremember

HEPC:THEUNDERLYINGCAUSEOFDEATH(AFTERLIVERTRANSPLANT)

12

LouReed’scaseandcausesofdeathinreal-lifehepCpa?ents

Wemaysoonremember LouReed’squote

HEPC:THEUNDERLYINGCAUSEOFDEATH(AFTERLIVERTRANSPLANT)

ALCOHOLUSEDISORDERS:AMAJORCAUSEOFLIVERTRANSPLANTANDOVERALLDEATH

13

Lacontribu/ondestroublesliésàl’alcoolaufardeaudel’hépa/teCn’estpas(plus)prise

encompte

Contribution of alcohol use disorders on the burden of chronic hepatitis C in France, 2008–2013: A nationwide retrospective cohort study

Michaël Schwarzinger, Sylvain Baillot, Yazdan Yazdanpanah, Jürgen Rehm, Vincent Mallet

Journal of Hepatology Volume 67, Issue 3, Pages 454-461 (September 2017)

DOI: 10.1016/j.jhep.2017.03.031

Copyright © 2017 European Association for the Study of the Liver Terms and Conditions

Journal of Hepatology 2017 67, 454-461DOI: (10.1016/j.jhep.2017.03.031) Copyright © 2017 European Association for the Study of the Liver Terms and Conditions

Risk for liver transplantation or premature liver death by alcohol use disorders and age in 2008 in French patients discharged with chronic HCV infection in 2008–2013 (N=97,347).

0,1

1,0

10,0

25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65

Adjusted

Odd

s-ra/o

(95%

CI)Co

mpa

redtoPa/

ents

with

outA

lcoh

olUseDisorde

rs

Agein2008

Alcohol Use Disorders and Premature Risk of Liver Transplantation or Liver Death in French Patients

Discharged with Chronic HCV Infection (n=95,253)

UncontrolledAlcoholUseDisordersin2008-2013

OneRecordofAlcoholRehabilita?onin2008-2013

OneRecordofAlcoholAbs?nenceaqerRehabilita?onin2008-2013

Kanwal F Gastroenterology 2017

AlcooletHépa/teC

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