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Background <p>Long-term follow-up is essential after a sustained virologic response (SVR) to direct-acting antivirals (DAAs) in patients with chronic hepatitis C. However, real-world continuity of care and determinants of disengagement are poorly characterized at the national level. Here, we quantified the follow-up continuity within Japan’s government-designated regional core centers and identified independent factors associated with transfer and self-discontinuation.</p> Methods <p>We conducted a retrospective multicenter cohort study of 3702 patients with chronic hepatitis C who achieved SVR at 16 regional core centers (2015–2018). Continuation was assessed using Kaplan–Meier analysis and competing-risk analysis, and Fine–Gray regression identified determinants of transfer and discontinuation.</p> Results <p>At 5&#xa0;years, 56% of the patients were followed up, 24% were transferred, and 18% self-discontinued. Older age was significantly associated with transfer (subdistribution hazard ratio [sHR] 1.41, 95% CI 1.23–1.61), whereas hepatocellular carcinoma (HCC) and other malignancies favored continuous follow-up. Self-discontinuation was more frequent with hepatitis C virus (HCV) serotype 2 (sHR 1.36, 95% CI 1.18–1.57) and less common among patients with advanced disease or prior hospitalization.</p> Conclusions <p>Within Japan’s core-center network, long-term continuation after SVR is high but not universal. Follow-up was generally maintained for patients with severe comorbidities, while disengagement was more likely among those with lower perceived risk. Strengthening low-intensity, structured support for such patients may improve the continuity and equity of post-SVR care. These findings provide a foundation for optimizing post-SVR care pathways in national liver disease networks.</p> Graphical abstract <p></p>

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Continuity of long-term follow-up in patients with chronic hepatitis C after sustained virologic response following direct-acting antiviral therapy: a nationwide real-world multicenter cohort study in Japan

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月27日

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  • Masatsugu Ohara,
  • Ritsuzo Kozuka,
  • Yoshihito Uchida,
  • Chikara Iino,
  • Ryo Sasaki,
  • Hiroki Tojima,
  • Kazuhito Kawata,
  • Satoru Kakizaki,
  • Yoshio Tokumoto,
  • Mizuki Endo,
  • Akira Asai,
  • Jun Inoue,
  • Kenji Nagata,
  • Hirokazu Takahashi,
  • Tetsuro Shimakami,
  • Koji Ogawa,
  • Masaru Enomoto,
  • Tadashi Ikegami,
  • Tatsuya Ide,
  • Naoya Sakamoto,
  • Masaaki Korenaga

摘要

Background

Long-term follow-up is essential after a sustained virologic response (SVR) to direct-acting antivirals (DAAs) in patients with chronic hepatitis C. However, real-world continuity of care and determinants of disengagement are poorly characterized at the national level. Here, we quantified the follow-up continuity within Japan’s government-designated regional core centers and identified independent factors associated with transfer and self-discontinuation.

Methods

We conducted a retrospective multicenter cohort study of 3702 patients with chronic hepatitis C who achieved SVR at 16 regional core centers (2015–2018). Continuation was assessed using Kaplan–Meier analysis and competing-risk analysis, and Fine–Gray regression identified determinants of transfer and discontinuation.

Results

At 5 years, 56% of the patients were followed up, 24% were transferred, and 18% self-discontinued. Older age was significantly associated with transfer (subdistribution hazard ratio [sHR] 1.41, 95% CI 1.23–1.61), whereas hepatocellular carcinoma (HCC) and other malignancies favored continuous follow-up. Self-discontinuation was more frequent with hepatitis C virus (HCV) serotype 2 (sHR 1.36, 95% CI 1.18–1.57) and less common among patients with advanced disease or prior hospitalization.

Conclusions

Within Japan’s core-center network, long-term continuation after SVR is high but not universal. Follow-up was generally maintained for patients with severe comorbidities, while disengagement was more likely among those with lower perceived risk. Strengthening low-intensity, structured support for such patients may improve the continuity and equity of post-SVR care. These findings provide a foundation for optimizing post-SVR care pathways in national liver disease networks.

Graphical abstract