Long-term serum ferritin dynamics in patients receiving antiviral treatment for hepatitis C virus infection.

BACKGROUND

Limited data exists regarding the long-term serum ferritin dynamics following sustained virologic response (SVR12) and factors associated with trends in changes among patients undergoing treatment for hepatitis C virus (HCV).

METHODS

Serum ferritin levels were assessed biannually in 1538 participants undergoing direct-acting antivirals (DAAs) or peginterferon plus ribavirin (PR) with a median of follow-up of 5.0 years after off-treatment week 12. We compared the differences in time-dependent slope coefficients of serum ferritin levels for factors of interest using the generalized estimating equations to identify predictors associated with favorable serum ferritin evolution.

RESULTS

Using univariable analysis, SVR12, aged ≤50 year, absence of metabolic dysfunction-associated steatotic liver disease (MASLD), and pre-treatment HCV RNA level ≤2,000,000 IU/mL were associated with favorable ferritin evolution. Multivariable analysis showed that SVR12 (adjusted slope coefficient difference: 7.50 ng/mL/year [95% CI: 3.37 to -11.63], p < 0.001) and absence of MASLD (adjusted slope coefficient difference: 4.16 ng/mL/year [95% CI: 7.91 to -0.41], p = 0.022) predicted favorable ferritin evolution. Among participants achieving SVR12, the ferritin evolution was not affected by DAA or PR treatment (crude slope coefficient difference: 3.33 ng/mL/year [95% CI: 12.78 to 6.12], p = 0.49). Absence of MASLD was associated with favorable ferritin evolution (adjusted slope coefficient difference: 2.86 ng/mL/year [95% CI: 5.39 to -0.33], p = 0.021).

CONCLUSION

Patients achieving SVR12, irrespective of types of treatment, exhibited more favorable long-term ferritin dynamics compared to those not achieving SVR12. Absence of MASLD may help improve long-term ferritin dynamics among patients achieving SVR12.