Association between interferon use and reduced metabolic and vascular complications among patients with hepatitis C

Abstract

We examined whether interferon treatment is associated with reduced metabolic/vascular complications in hepatitis C virus patients. The study had historical prospective cohort design using Maryland Medicaid administrative data (2006–2009). The end point was the incidence rate of mild, severe and combined mild/severe events from the Diabetes Complications Severity Index (DCSI). Interferon-treated and -untreated hepatitis C virus patients were matched on baseline covariates. Using multivariate counting process Cox regressions, we modeled the association between interferon receipt of at least 24 weeks and DCSI events incidence rate. Treated whites had similar rate of mild DCSI events, significantly 64% (p < 0.01) lower rate of severe DCSI events, and overall 29% (p = 0.14) lower rate of mild/severe DCSI events, compared with untreated whites. Compared with untreated blacks, treated blacks had a similar rate of DSCI events. Future studies should confirm our findings and should include important clinical variables such as viral genotype, virologic count and achieving sustained virologic response.

Keywords::

• chronic hepatitis C
• diabetes
• interferon
• vascular disease

Disclaimer

VV Chirikov takes full responsibility for the work as a whole, including study design, access to data and the decision to submit and publish the manuscript. All authors have made a substantial contribution to the research design, the acquisition, analysis or interpretation of data; have drafted the paper and revised it critically and have approved the final version of this article. VV Chirikov contributed in concept and design, performed the research, analyzed and interpreted the data, wrote and critically revised manuscript; FT Shaya acquired data, interpreted data and critically revised manuscript; CD Howell contributed in study design, interpreted data and critically revised manuscript.

Financial & competing interest disclosure

CD Howell has served as a speaker, a consultant and an advisory board member for Janssen, Inc., and has received research funding from Boehringer Ingelheim Pharmaceuticals, Inc., Bristol Myer Squibb, Inc. and Gilead Sciences, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Due to the broad hepatitis C infection in the past and its extended latency period, it is expected that progressively more people living with the disease will continue experiencing the symptoms of the virus in the near future.

• A bi-directional link between type 2 diabetes and liver disease has been termed a ‘vicious circle’ in that either of the two diseases reinforces the complications of the other disease.

• Hepatitis C has been shown to increase the risk of diabetes by more than 200% and cardiovascular disease by 97%.

• There is substantial evidence suggesting that achieving sustained virologic response after therapy halves the risk of developing hyperglycemia, insulin resistance, diabetes and stroke, but evidence on clinically important outcomes such as metabolic and vascular complications in whites and blacks is limited.

• The major contribution of our study is that the authors examined the association effect of interferon therapy on the incidence rate of metabolic and vascular events. The authors found interferon therapy treatment of at least 24 weeks among whites to be associated with a reduced risk for severe vascular/metabolic complications.

• Once confirmed, the authors’ findings could have important implications for devising new innovative multidisciplinary methods for treating the vicious circle between chronic hepatitis C and metabolic and vascular diseases.