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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).
In our tertiary care …
Contributors AL and LK have equally contributed. Conception and design: AL, LK and SP. Analysis and interpretation of the data: AL, LK and SP. Drafting of the article: AL, LK and SP. Critical revision of the article for important intellectual content: all the authors. Final approval of the article: all the authors.
Competing interests LK is a board member of Gilead. AV-P received personal fees from Gilead, BMS, Janssen, MSD, Abbvie, Roche. PS was board member of Gilead and BMS. Workshop or meeting invitation: Gilead, BMS, MSD, AbbVie, Mayoloy-Spindler, Janssen. SP was speaker for BMS, Boehringer Ingelheim, Janssen Gilead, Roche, MSD, Novartis, Abbvie; received grants from BMS, Gilead, Roche, MSD and is board member of BMS, Boehringer Ingelheim, Janssen, Gilead, Roche, MSD, Abbvie.
Provenance and peer review Not commissioned; internally peer reviewed.