P5586 - Impact of Direct-Acting Antivirals on Hematologic, Oncologic, Healthcare Utilization, and Mortality Outcomes in Hepatitis C: A Matched Cohort Analysis

Fayaz Khan, MD¹, Mhd Kutaiba Albuni, MD², Sana Rabeeah, MD³, Mohammed Abu-Rumaileh, MD³, Muaz Alsabbagh, MD⁴, Shahem Abbarh, MD⁵, Yusuf Omar Hallak, MD³, Maram Albandak, MD³, Bisher Sawaf, MD⁶, Sami Ghazaleh, MD⁷
1TriHealth, Cincinnati, OH; 2Department of Internal Medicine, TriHealth Inc., Cincinnati, Cincinnati, OH; 3The University of Toledo, Toledo, OH; 4Detroit Medical Center/Wayne State University, Cleveland, OH; 5Georgetown University MedStar Health, Baltimore, WA; 6University of Toledo Medical Center, Toledo, OH; 7University of Toledo, Toledo, OH

Introduction: Direct-acting antivirals (DAAs) have revolutionized the treatment of hepatitis C virus (HCV), but their broader systemic effects, particularly on extrahepatic outcomes, remain incompletely characterized. This study evaluated the impact of DAA therapy on hematologic, oncologic, healthcare utilization, and mortality outcomes in a large real-world cohort of HCV-infected adults.

Methods: A retrospective cohort study was conducted using the TriNetX Global Network. Adults with HCV infection were included, excluding individuals with HIV or chronic hepatitis B. Patients treated with DAAs were matched 1:1 to untreated HCV patients using propensity scores based on demographics and comorbidities. Each group included approximately 91,000 patients. Outcomes were assessed using Cox proportional hazards modeling.

Results: DAA therapy was associated with significantly reduced risk of hematologic complications including thrombocytopenia (HR 0.67; 95% CI 0.60–0.75), iron deficiency anemia (HR 0.78; 95% CI 0.70–0.87), coagulopathy (HR 0.53; 95% CI 0.43–0.66), and aplastic anemia (HR 0.58; 95% CI 0.46–0.73). No significant differences were observed for hemolytic anemia, cryoglobulinemia, amyloidosis, porphyria cutanea tarda, or autoimmune hemolytic anemia. Oncologic outcomes favored DAA use, with reduced hepatocellular carcinoma (HR 0.86; 95% CI 0.82–0.90) and AFP >20 ng/mL (HR 0.58; 95% CI 0.55–0.61), while monoclonal gammopathy of undetermined significance (MGUS) was more common (HR 1.22; 95% CI 1.08–1.39). Other oncologic outcomes including lymphomas and solid tumors showed no significant differences. DAA-treated patients had lower healthcare utilization, including hospitalizations (HR 0.72; 95% CI 0.68–0.75) and outpatient visits (HR 0.77; 95% CI 0.74–0.81), as well as fewer elevated liver enzyme events (HR 0.79; 95% CI 0.76–0.82). All-cause mortality was significantly lower in the DAA-treated group (HR 0.58; 95% CI 0.55–0.60).

Discussion: In a large matched cohort of HCV-infected adults, DAA therapy was associated with significant reductions in hematologic complications, hepatocellular carcinoma, healthcare utilization, and all-cause mortality. These findings support the broad systemic benefits of antiviral therapy and highlight the need for continued research on long-term outcomes after HCV eradication.

Disclosures:
Fayaz Khan indicated no relevant financial relationships.
Mhd Kutaiba Albuni indicated no relevant financial relationships.
Sana Rabeeah indicated no relevant financial relationships.
Mohammed Abu-Rumaileh indicated no relevant financial relationships.
Muaz Alsabbagh indicated no relevant financial relationships.
Shahem Abbarh indicated no relevant financial relationships.
Yusuf Omar Hallak indicated no relevant financial relationships.
Maram Albandak indicated no relevant financial relationships.
Bisher Sawaf indicated no relevant financial relationships.
Sami Ghazaleh indicated no relevant financial relationships.

Fayaz Khan, MD¹, Mhd Kutaiba Albuni, MD², Sana Rabeeah, MD³, Mohammed Abu-Rumaileh, MD³, Muaz Alsabbagh, MD⁴, Shahem Abbarh, MD⁵, Yusuf Omar Hallak, MD³, Maram Albandak, MD³, Bisher Sawaf, MD⁶, Sami Ghazaleh, MD⁷. P5586 - Impact of Direct-Acting Antivirals on Hematologic, Oncologic, Healthcare Utilization, and Mortality Outcomes in Hepatitis C: A Matched Cohort Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.