Quelle est la contribu/on des troubles liés à l alcool au fardeau de l hépa/te C?

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1 Quelle est la contribu/on des troubles liés à l alcool au fardeau de l hépa/te C? Vincent Mallet Université Paris Descartes, AP HP, Inserm, Paris, France vincent.mallet@aphp.fr

2 Conflits d intérêts Vincent Mallet has been a scien?fic advisor or consultant for Gilead, Abbvie, MSD, Janssen-Cilag, Bristol Myers Squibb, and THEN (Transla?onal Health Economics Network), has received payment for lectures through speakers bureaus for Abbvie, Bristol Myers Squibb, Gilead, JJ/Janssen-Cilag, Novar?s and Roche, and owns stocks of Lingha systems.

3 EASL recommenda?ons on treatment of hepa??s C J Hepatol. 2015;63: Universal access to treatment is the objec/ve

From: Associa?on Between Sustained Virological Response to Interferon-based treatment and All-Cause Mortality Among Pa?ents With Chronic Hepa??s C and Advanced Hepa?

5 From: Associa?on Between Sustained Virological Response to Interferon-based treatment and All-Cause Mortality Among Pa?ents With Chronic Hepa??s C and Advanced Hepa?c Fibrosis All-cause Mortality % No. at risk Without SVR With SVR Hepatocellular Carcinoma % No. at risk Without SVR With SVR P <.001 ALL-CAUSE MORTALITY Without SVR With SVR Time P <.001 HEPATOCELLULAR CARCINOMA Without SVR With SVR Time Liver-related Mortality or Liver Transplanta/on, % No. at risk Without SVR With SVR Liver Failure % No. at risk Without SVR With SVR LIVER-RELATED MORTALITY OR LIVER TRANSPLANTATION P <.001 Without SVR With SVR Time P <.001 LIVER FAILURE Without SVR With SVR Time Van der Meer, AJ, et al. JAMA 2012;308: Copyright 2015 American Medical Associa?on. All rights reserved.

6 From: Life Expectancy in Pa?ents With Chronic HCV Infec?on and Cirrhosis Compared With a General Popula?on Cumula/ve Overall Survival % PATIENTS WITH SVR Matched popula/on 80 With SVR P= No. Time, y at risk Cumula/ve Overall Survival % P<.001 PATIENTS WITHOUT SVR Matched popula/on Without SVR No. Time, y at risk Overall Survival in Pa/ents With Chronic Hepa//s C Virus Infec/on and Advanced Hepa/c Fibrosis With and Without Sustained Virological Response (SVR) to Interferon-based Treatment Compared With an Age- and Sex-Matched General Popula/on Time zero is 24 weeks following cessa/on of an/viral therapy, at which /me it was determined whether pa/ents adained SVR. Van der Meer, AJ, et al. JAMA 2014;312: Copyright 2015 American Medical Associa?on. All rights reserved.

L expérience Ecossaise Surmortalité hépa/que (x6) des pa/ents HCV guéris Hamish Innes, Scott McDonald, Peter Hayes, John F. Dillon, Sam Allen, David Goldberg, Peter R. Mills, Stephen T.

7 L expérience Ecossaise Surmortalité hépa/que (x6) des pa/ents HCV guéris 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

8 Innes H, et al. Hepatology 2015;62: Date of prepara?on April 2016 I GBL/VIEX/0416/0488c

9 Hazard reduc?on associated with SVR (vs.non-svr), for each outcome event, according to APRI. Es?mates are adjusted for differences in basic demographics; medical comorbidi?es; viral genotype; behavior factors and liver func?on tests. (N=3385) OUTCOME APRI (inferred disease stage) HAZARD RATIO (SVR vs non-svr) P-VALUE FOR SVR* APRI INTERACTION TERM Liver mortality <0.7 (mild) 0.7 (non-mild) 0.50 ( ) 0.20 ( ) Non-liver mortality <0.7 (mild) 0.7 (non-mild) 0.85 ( ) 0.55 ( ) All-cause mortality <0.7 (mild) 0.7 (non-mild) 0.82 ( ) 0.35 ( ) Severe liver morbidity <0.7 (mild) 0.7 (non-mild) 0.27 ( ) 0.20 ( ) Cardiovascular disease <0.7 (mild) 0.7 (non-mild) 0.91 ( ) 0.61 ( ) Respiratory diseases <0.7 (mild) 0.7 (non-mild) 1.04 ( ) 0.84 ( ) Neoplasms <0.7 (mild) 0.7 (non-mild) 1.11 ( ) 0.90 ( ) Alcohol intoxica?on <0.7 (mild) 0.7 (non-mild) 0.74 ( ) 0.40 ( ) Drug intoxica?on <0.7 (mild) 0.7 (non-mild) 0.74 ( ) 0.81 ( ) Violence-related injury <0.7 (mild) 0.7 (non-mild) 0.58 ( ) 0.45 ( ) Innes H, et al. Hepatology 2015;62: Hazard Ra/o

From: The Prevalence of Hepa??s C Virus Infec?on in the United States, 1999 through 2002 7.0 7.0 Propor/on An/-HCV-Posi/ve, % 6.

0 1988-1994 1999-2002 Propor/on An/-HCV-Posi/ve, % 6.

Birth Figure Legend: Prevalence of an/bodies to hepa//s C virus (HCV) by age group (A) and year of birth (B) in the Third Na/onal

11 From: The Prevalence of Hepa??s C Virus Infec?on in the United States, 1999 through Propor/on An/-HCV-Posi/ve, % Propor/on An/-HCV-Posi/ve, % Age at Time of Survey, y Year of Birth Figure Legend: Prevalence of an/bodies to hepa//s C virus (HCV) by age group (A) and year of birth (B) in the Third Na/onal Health and Nutri/on Examina/on Survey (NHANES III, ) and the current NHANES ( ).The ver/cal bars represent 95% CIs. Armstrong GL, et al. Ann Intern Med 2006;144: Copyright American College of Physicians. All rights reserved. Date of prepara?on April 2016 I GBL/VIEX/0416/0488c

12 Lou Reed s case and causes of death in real-life hep C pa?ents We may soon remember HEP C: THE UNDERLYING CAUSE OF DEATH (AFTER LIVER TRANSPLANT) 12

13 Lou Reed s case and causes of death in real-life hep C pa?ents We may soon remember Lou Reed s quote HEP C: THE UNDERLYING CAUSE OF DEATH (AFTER LIVER TRANSPLANT) ALCOHOL USE DISORDERS: A MAJOR CAUSE OF LIVER TRANSPLANT AND OVERALL DEATH 13

14 La contribu/on des troubles liés à l alcool au fardeau de l hépa/te C n est pas (plus) prise en compte

15 Contribution of alcohol use disorders on the burden of chronic hepatitis C in France, : A nationwide retrospective cohort study Michaël Schwarzinger, Sylvain Baillot, Yazdan Yazdanpanah, Jürgen Rehm, Vincent Mallet Journal of Hepatology Volume 67, Issue 3, Pages (September 2017) DOI: /j.jhep Copyright 2017 European Association for the Study of the Liver Terms and Conditions

18 Alcohol Use Disorders and Premature Risk of Liver Transplantation or Liver Death in French Patients Discharged with Chronic HCV Infection (n=95,253) 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 (N=97,347). Adjusted Odds-ra/o (95% CI) Compared to Pa/ents without Alcohol Use Disorders 10,0 1,0 0,1 Uncontrolled Alcohol Use Disorders in One Record of Alcohol Rehabilita?on in One Record of Alcohol Abs?nence aqer Rehabilita?on in Age in 2008 Journal of Hepatology , DOI: ( /j.jhep ) Copyright 2017 European Association for the Study of the Liver Terms and Conditions

20 Kanwal F Gastroenterology 2017

21 Alcool et Hépa/te C Les troubles liés à l alcool sont fréquents chez les pa?ents avec une hépa?te C et ne sont, en général, pas pris en compte Les troubles liés à l alcool contribuent largement au fardeau de l hépa?te C dans les pays industrialisés Les modifica?ons comportementales (sevrage) améliorent la survie des pa?ents à risque avec une hépa?te C

HEPATITIS C BASICS ILAN S. WEISBERG, MD DIRECTOR HEPATOLOGY LENOX HILL HOSPITAL JUNE 20, 2015

HEPATITIS C BASICS ILAN S. WEISBERG, MD DIRECTOR HEPATOLOGY LENOX HILL HOSPITAL JUNE 20, 2015 Overview Understand the GLOBAL and US burden of chronic HCV infec