Quelleestlacontribu/ondestroublesliésàl’alcoolaufardeaudel’hépa/teC?
VincentMalletUniversitéParisDescartes,AP—HP,Inserm,Paris,France
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
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
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
AlcooletHépa/teC
• Lestroublesliésàl’alcoolsontfréquentschezlespa?entsavecunehépa?teCetnesont,engénéral,pasprisencompte
• Lestroublesliésàl’alcoolcontribuentlargementaufardeaudel’hépa?teCdanslespaysindustrialisés
• Lesmodifica?onscomportementales(sevrage)améliorentlasurviedespa?entsàrisqueavecunehépa?teC