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Mortality associated with the treatment of HCV with direct-acting antivirals
  1. Anne Laurain,
  2. Laura Kramer,
  3. Philippe Sultanik,
  4. Anaïs Vallet-Pichard,
  5. Philippe Sogni,
  6. Stanislas Pol
  1. Université Paris Descartes; APHP, Unité d'Hépatologie, Hôpital Cochin; INSERM U1223 and USM20, Institut Pasteur, Paris, France
  1. Correspondence to Dr Anne Laurain, Département d'Hépatologie, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75679 Paris Cedex 14, France; anne.laurain{at}aphp.fr

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We read with interest the study by Welzel et al1 confirming the high efficacy of oral direct-acting antiviral agents (DAAs) for the treatment of chronic HCV infection.2 Results about safety are less clear, since in these patients who have a high risk of hepatic decompensation or death within 12 months, the rate of death was 7.8% during treatment and the 12 weeks post-treatment. These deaths and most safety events were associated with advanced liver disease and not considered treatment related. The largest phase III studies (COSMOS, ION1 and ION3, SAPPHIRE) did not report any death during DAA treatment and severe adverse events occurring during therapy were considered to be unlikely related to DAAs.3 In real-life clinical settings, mortality has been observed in around 0.5% (0.3% for the French ANRS CO22 HEPATHER cohort and 0.6% for the US TARGET cohort).

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