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Alshoaibi IA, Al-Gamli A, Abdullah M, Abdo B, Alzanen KH, Alhakamy M, Al-Namer M, Ahmed F, Tamesh M, Mahdi W, Abdo Z, Mohammed M. Effectiveness of Ledipasvir-Sofosbuvir 12 Weeks After Hepatitis C Virus Genotype 1 Infection and the Factors Associated With Sustained Virologic Response: A Retrospective Study. Cureus 2024; 16:e68249. [PMID: 39350869 PMCID: PMC11439843 DOI: 10.7759/cureus.68249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND The combination of ledipasvir and sofosbuvir (LDV/SOF) has been licensed to treat genotype 1 hepatitis C virus infection (HCV) with a 12-week regimen. However, there is scant data from Yemen regarding this combination regimen. Here, we investigate sustained virologic responses (SVR) 12 weeks after HCV treatment with LDV/SOF regimens and the factors that contribute to SVR failure. MATERIAL AND METHOD A retrospective cross-sectional study was conducted at Althora General Hospital in Ibb, Yemen, from June 1, 2019, to October 31, 2022, on 53 cases with HCV genotype 1 infection who received combined therapy of LDV/SOF and completed treatment for 12 weeks. The clinical characteristics and treatment follow-up were obtained from patient medical records. Factors associated with SVR failure were investigated in univariate analysis with odds ratio (OR) and 95% confidence interval (CI). RESULT The mean age was 50 ± 15.3 years, and most cases were female (n=36, 67.9%). Comorbidities were diabetes, hypertension, and fatty liver, which were represented in 12 (22.6%), nine (17.0%), and eight (15.1%) cases, respectively. A total of 13 (24.5%) patients had compensated liver cirrhosis, while the remaining 40 patients (75.5%) were non-cirrhotic healthy individuals. The baseline viral load (HCV RNA) was more than 800000 IU/mL in 21 patients (39.6%). Early virological response (ERV) was achieved in 51 patients (96.2%). After treatment, 46 of the patients (86.8%) achieved SVR at Week 12, while failure occurred in two patients (3.8%) and relapse occurred in five patients (9.4%). Blood liver enzymes, including alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase, returned to normal, with statistically significant improvements in non-cirrhotic healthy persons than compensated liver cirrhosis individuals (p= 0.006, 0.006, and 0.010; respectively). Factors associated with SVR failure were older age (OR:1.13; 95% CI: 1.03-1.30, p=0.009), presence of liver cirrhosis (OR: 5.48; 95% CI: 1.04-28.98, p=0.031), having diabetes (OR: 6.33; 95% CI: 1.19-37.93, p= 0.019), baseline higher viral load (OR: 2.27; 95% CI: 0.45-12.73, p<0.001), and not achieving EVR (OR:7.63; 95% CI: 3.77- 17.78, p= 0.009). CONCLUSION In this study, we found that LDV/SOF regimens are effective against HCV genotype one infection, allowing for the expansion of 12-week treatment for suitable patients in clinical settings. Additionally, older age, liver cirrhosis, diabetes, higher pretreatment viral load, and non-completion of EVR were associated with SVR failure. However, due to the small number of HCV genotype 1 infected individuals in this study, more corporate data is required to get a clear conclusion.
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Affiliation(s)
| | | | | | - Basheer Abdo
- Internal Medicine, School of Medicine, Ibb University, Ibb, YEM
| | | | | | - Mamoon Al-Namer
- Internal Medicine, School of Medicine, Ibb University, Ibb, YEM
| | - Faisal Ahmed
- Urology, School of Medicine, Ibb University, Ibb, YEM
| | - Munther Tamesh
- Pharmacy, University of Science and Technology, Ibb, YEM
| | - Wadhah Mahdi
- Pharmacy, University of Science and Technology, Ibb, YEM
| | - Zeyad Abdo
- Pharmacy, University of Science and Technology, Ibb, YEM
| | - Marwa Mohammed
- General Practice, School of Medicine, Ibb University, Ibb, YEM
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Determinant Factors of the Direct Medical Costs Associated with Genotype 1 Hepatitis C Infection in Treatment-Experienced Patients. Drugs R D 2016; 15:335-49. [PMID: 26416653 PMCID: PMC4662942 DOI: 10.1007/s40268-015-0109-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective Limited evidence is available on predictors of medical resource utilization (MRU) and related direct costs, especially in treatment-experienced patients infected with genotype 1 hepatitis C virus (HCV). This study aimed at investigating patient and treatment characteristics that predict MRU and related non-drug costs in treatment-experienced patients with chronic hepatitis C (CHC) treated with simeprevir (SMV) or telapravir (TVR) in combination with pegylated interferon and ribavirin (PegIFN/R). Patients and Methods A total of 709 patients who completed the 72-week ATTAIN trial were included in the study. Cost data were analysed from the UK NHS perspective. Descriptive statistics and regression analyses were used to determine patterns and predictors of total MRU-related costs associated with SMV/PegIFN/R and TVR/PegIFN/R. Results Independent predictors for total MRU-related costs were age, region and the following interaction terms: (1) gender × F3–F4 METAVIR score × baseline viral load (BLVL), (2) body mass index (BMI) × F3–F4 METAVIR score × prior response to PegIFN/R and (3) gender × achievement of SVR at 12 weeks (SVR12) × BLVL. A F3–F4 METAVIR score was a stronger predictor of total MRU-related costs than SVR12. Predictors of adverse events included older age, female gender, low BMI, TVR/PegIFN/R and SVR12. Wilcoxon rank sum test revealed comparable total MRU-related costs between SMV/PegIFN/R and TVR/PegIFN/R. Conclusion To the best of our knowledge, this study is the first to describe the relationship between commonly admitted predictors of MRU-related costs and their joint effect on total MRU-related costs in treatment-experienced patients with CHC. The identified predictors of MRU-related costs suggest that significant treatment costs can be avoided by starting treatment early before the disease progresses. Furthermore, adverse events seem to be the most important factor to take into consideration for the choice of treatment, especially when therapeutic options are associated with similar levels of medical resource utilization and associated costs. Electronic supplementary material The online version of this article (doi:10.1007/s40268-015-0109-5) contains supplementary material, which is available to authorized users.
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Abstract
Hepatitis C virus (HCV) infection in the elderly population is a global medical burden and healthcare utilization concern. The majority of patients with hepatitis C in the USA are "baby boomers," who were born between 1945 and 1965. Consistently worldwide, HCV infection in elderly population is overrepresented and poses public health concerns. These individuals have been infected now for over two decades and are presenting with advanced liver disease. Traditionally, the use of pegylated interferon-based therapy has been limited in the elderly because of its adverse effects. The sustained virologic responses have also tended to be lower in the elderly than in younger adults. The emergence of non-interferon-based therapy with direct acting antiviral agents has expanded the pool of patients eligible for treatment. These agents have been found to be effective, tolerable, and safe in the elderly population.
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Nan YM, Zhang YG, Zheng HW, An CM, Li YS, Zhang Y, Sun DX, Li CY, Li Q, Tong LX, Kong LB, Zhao SX, Wang RQ, Meng P, Su SS, He H, Niu XM. Individualized treatment strategies and predictors of virological response for chronic hepatitis C: a multicenter prospective study from China. Int J Clin Exp Med 2015; 8:14871-14884. [PMID: 26628969 PMCID: PMC4658858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/26/2015] [Indexed: 06/05/2023]
Abstract
Combination therapy comprising pegylated interferon-alpha (PegIFNα) and ribavirin (RBV) has been the standard of care for the chronic hepatitis C patients for more than a decade. Recently, direct antiviral agents show better efficacy, tolerance, and shorter treatment duration. However, the prohibitive costs of the regimens limit their use in developing countries where most of the HCV infection exists. Optimizing the treatment and understanding the host- and virus-factors associated with viral clearance were necessary for individualizing therapy to maximize sustained virologic response. To explore individualized antiviral strategies with PegIFNα-2a/IFNα-2b plus ribavirin for CHC patients, and to clarify predictive factors for virological response. A cohort of 314 patients were included in this open-label, prospective clinical trial, which received individualized doses of PegIFNα-2a or IFNα-2b combined with RBV according to body weight, disease status and complications, with the duration of 44 weeks after HCV RNA undetectable. All the IL-28B (rs8099917), IL-17A (rs8193036), IL-17B (rs2275913) and PD-1.1 SNPs were genotyped using the TaqMan system. The sustained virological response (SVR) in PegIFNα-2a group was significantly higher than that in IFNα-2b (85.8% vs 75.0%, P = 0.034), especially in HCV genotype 1 (84.0% vs 64.3%, P = 0.022). However, no significant differences were found in rapid virological response (RVR), complete early virological response (cEVR) and SVR between PegIFNα-2a and IFNα-2b according to different doses, respectively. The genotype frequency of IL-28B TT in patients with cEVR, SVR was higher than that in non-responsed patients (93.8% vs 78.1%, χ(2) = 7.827, P = 0.005; 95.9% vs 80.4%, χ(2) = 9.394, P = 0.002). No significant correlation between the genotype distribution of IL-17A, IL-17B and PD-1.1 with virological response. Individualized regimens of PegIFNα-2a/RBV and IFNα-2b/RBV could achieve satisfied virological response in Chinese HCV patients. The IL-28B (rs8099917) TT genotype is a clinical usefully marker for cEVR and SVR.
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Affiliation(s)
- Yue-Min Nan
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Yu-Guo Zhang
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Huan-Wei Zheng
- Department of Infectious Disease, The Fifth Hospital of Shijiazhuang CityShijiazhuang, China
| | - Chun-Mian An
- Department of Traditional and Western Medical Hepatology, People’s Hospital of Xingtai CityXingtai, China
| | - You-Sheng Li
- Department of Liver Disease, Infectious Diseases Hospital of Handan CityHandan, China
| | - Ying Zhang
- Department of Liver Disease, Infectious Diseases Hospital of Cangzhou CityCangzhou, China
| | - Dian-Xing Sun
- Department of Liver Disease, Bethune International Peace HospitalShijiazhuang, China
| | - Cang-You Li
- Department of Liver Disease, Infectious Diseases Hospital of Cangzhou CityCangzhou, China
| | - Qiang Li
- Department of Liver Disease, Infectious Diseases Hospital of Handan CityHandan, China
| | - Li-Xin Tong
- Department of Liver Disease, The First Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Ling-Bo Kong
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Su-Xian Zhao
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Rong-Qi Wang
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Ping Meng
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Shan-Shan Su
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Huan He
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical UniversityShijiazhuang, China
| | - Xue-Min Niu
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical UniversityShijiazhuang, China
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Vespasiani-Gentilucci U, Galati G, Gallo P, De Vincentis A, Riva E, Picardi A. Hepatitis C treatment in the elderly: New possibilities and controversies towards interferon-free regimens. World J Gastroenterol 2015; 21:7412-7426. [PMID: 26139987 PMCID: PMC4481436 DOI: 10.3748/wjg.v21.i24.7412] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/10/2015] [Accepted: 05/21/2015] [Indexed: 02/06/2023] Open
Abstract
Due to the progressive aging of the hepatitis C virus (HCV) population which have acquired the infection during its maximum spread after the Second World War, the management of the elderly HCV-infected patient is emerging as a hot topic. Unfortunately, although it is recognized that the progression of HCV-related liver disease gets faster with aging, and that even extra-hepatic manifestations of HCV infection are probably worse in the elderly, till now, treatment attempts in this population have been significantly limited by the well-known contraindications and side effects of interferon (IFN). The arrival of several new anti-HCV drugs, and the possibility to combine them in safe and effective anti-viral regimens, is relighting the hope of a cure for many elderly patients who had been cut out of IFN-based treatments. However, although these new regimens will be certainly more manageable, it should be underscored that IFN-free doesn’t mean free from any contraindication or side-effect. Moreover, one issue which promises to become central is that of the possible interactions between antiviral therapy and the multiple drugs frequently assumed by elderly patients because of comorbidities. In this review, we will revise the epidemiology pointing to HCV as an infection of the elderly, the evidences that HCV harms the health of the aged patient more than that of the young one, and the available experiences of HCV treatment in the elderly with the “old” IFN-based regimens and with the newer drugs. We will conclude that the availability of IFN-free regimens should prompt us to change our mind and consider a significantly larger number of possible candidates among elderly patients, who would take significant advantage from viral eradication. Rather than the anagraphic age, drug-drug interactions and, mainly in case of economic restrictions, an evaluation of life expectancy dependent on liver disease with respect to that dependent on comorbidities, are likely to be the key issues guiding treatment indication in the next future. The sooner we will change our mind with respect to an a priori obstacle for anti-HCV treatment in the elderly, the sooner we will begin to spare many aged HCV patients from avoidable liver-related complications.
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Rheem J, Sundaram V, Saab S. Antiviral Therapy in Elderly Patients With Hepatitis C Virus Infection. Gastroenterol Hepatol (N Y) 2015; 11:294-346. [PMID: 27482173 PMCID: PMC4962680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The emergence of direct-acting antiviral (DAA) agents has revolutionized the treatment schema for hepatitis C virus (HCV) infection. From cure rates to tolerability, DAA agents have shown outstanding profiles compared with the prior therapy of pegylated interferon with ribavirin. However, the efficacy and safety profiles of DAA therapy in older patients, particularly the elderly, have been unclear, and patients in the 1945 to 1965 birth cohort constitute the largest proportion of the HCV population in the United States. Treating elderly patients with pegylated interferon and ribavirin has been challenging due to the frequent presence of multiple comorbidities in the elderly and high discontinuation rates caused by adverse events. Now, as more DAA agents have become widely studied and approved, subgroup analyses for the elderly population are being elucidated. Analysis of the current literature shows that these agents have been effective, well tolerated, and safe in the elderly population. This article highlights the efficacy and safety differences in interferon-based therapy and interferon-free regimens for elderly patients with HCV infection.
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Affiliation(s)
- Justin Rheem
- Dr Rheem is a resident in the Department of Medicine at Harbor-University of California at Los Angeles Medical Center in Torrance, California. Dr Sundaram is an assistant director in the Division of Hepatology at Cedars-Sinai Medical Center in Los Angeles, California. Dr Saab is a professor in the Department of Medicine and the Department of Surgery at the University of California at Los Angeles in Los Angeles, California
| | - Vinay Sundaram
- Dr Rheem is a resident in the Department of Medicine at Harbor-University of California at Los Angeles Medical Center in Torrance, California. Dr Sundaram is an assistant director in the Division of Hepatology at Cedars-Sinai Medical Center in Los Angeles, California. Dr Saab is a professor in the Department of Medicine and the Department of Surgery at the University of California at Los Angeles in Los Angeles, California
| | - Sammy Saab
- Dr Rheem is a resident in the Department of Medicine at Harbor-University of California at Los Angeles Medical Center in Torrance, California. Dr Sundaram is an assistant director in the Division of Hepatology at Cedars-Sinai Medical Center in Los Angeles, California. Dr Saab is a professor in the Department of Medicine and the Department of Surgery at the University of California at Los Angeles in Los Angeles, California
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Abstract
Although HCV infection mainly induces liver injury, chronic disease is systemic. Moreover, host and viral factors, as well as comorbidities, may influence the chance of achieving a sustained virological response or disease outcome. Although there are sufficient data on the use of peg-interferon and ribavirin in patients with comorbidities, there is very little data on first generation protease inhibitors, which include significant drug-drug interactions and have therefore been administered with caution in these patients. The availability of new, more effective direct acting antivirals should significantly change this scenario. All these issues are discussed in this review.
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Affiliation(s)
- Vincenzo Boccaccio
- Department of Internal Medicine, A.O. Fatebenefratelli e Oftalmico, Milan, Italy
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Yang Z, Zhuang L, Yang L, Liu C, Lu Y, Xu Q, Chen X, Chen L. Efficacy and safety of peginterferon plus ribavirin for patients aged ≥ 65 years with chronic hepatitis C: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2014; 38:440-450. [PMID: 24176812 DOI: 10.1016/j.clinre.2013.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 08/04/2013] [Accepted: 08/29/2013] [Indexed: 02/08/2023]
Abstract
METHODS Studies up to August 30, 2012 of the efficacy and safety of peginterferon plus ribavirin therapy in CHC patients aged≥65 years were systematically identified in PubMed, Ovid, Web of Knowledge and Cochrane Library databases. A meta-analysis was performed using both fixed- and random-effects models based on heterogeneity across studies. RESULTS The overall sustained virological response (SVR) in CHC patients aged≥65 years was significantly lower than in patients aged<65 years on both intention-to-treat (ITT; 42.0% vs. 60.1%, respectively; P<0.00001) and per-protocol (PP; 54.4% vs. 67.4%, respectively; P=0.002) analyses, including treatment-naïve patients. Subgroup analysis showed that patients≥65 years with either hepatitis C virus (HCV) genotype 1/4 or 2/3 had lower SVR rates than younger patients. No statistically significant differences were observed between the two groups in terms of rapid virological response (RVR) and early virological response (EVR) rates (both P≥0.05). However, the end-of-treatment virological response (ETR) rate was lower in patients≥65 years, who also had a significantly higher risk of relapse than those aged<65 years (39.8% vs. 26.9%, respectively; P<0.00001). The discontinuation rate in the older patients was also significantly higher than in the younger patients (25.5% vs. 14.8%, respectively; P<0.00001). Ribavirin dose reduction in the older patients treated with peginterferon plus ribavirin was also significantly higher than in younger patients (44.5% vs. 32.8%, respectively; P<0.00001). CONCLUSION Peginterferon plus ribavirin therapy was effective for older patients with CHC, particularly those with HCV genotype 2/3. Response-guided therapy can be used for older patients with genotype 1/4, but such patients had poorer treatment adherence, leading to poorer treatment efficacy.
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Affiliation(s)
- Zongguo Yang
- Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China
| | - Liping Zhuang
- Shanghai Medical College, Fudan University, Department of Oncology, 200032 Shanghai, PR China; Shanghai Cancer Center, Department of Integrative Medicine, 200032 Shanghai, PR China
| | - Lei Yang
- The Central Hospital of China Aerospace Corporation, 100049 Beijing, PR China
| | - Cheng Liu
- Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China
| | - Yunfei Lu
- Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China
| | - Qingnian Xu
- Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China
| | - Xiaorong Chen
- Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China.
| | - Liang Chen
- Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China.
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Conti F, Vitale G, Andreone P. Treating hepatitis C in the elderly: the future is near? Expert Opin Pharmacother 2014; 15:2019-28. [PMID: 25154694 DOI: 10.1517/14656566.2014.945422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The population of patients with hepatitis C is aging. In some countries, the prevalence of hepatitis C virus (HCV) is actually greater in older patients than in younger individuals. It is also anticipated that hepatitis C will increasingly become a disease of older persons. However, patients older than 70 years are typically excluded from clinical trials. The decision to treat older patients is complex and cannot be made at the sole discretion of the physician. AREAS COVERED There is an urgent need to analyze treatment outcomes in the elderly to examine response rates in order to aid in therapeutic decision making. EXPERT OPINION In geriatric HCV-infected patients, dual therapy with pegylated IFN plus ribavirin is associated with a lower sustained virologic response and a higher discontinuation rate. Even the first-generation protease inhibitors are associated with high rates of side effects, in particular in elderly patients with a high prevalence of comorbidities. The recent development of interferon-sparing regimens could change the treatment paradigm in this setting, and a much larger number of patients could have access to the antiviral therapy programs.
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Affiliation(s)
- Fabio Conti
- University of Bologna, Department of Medical and Surgical Sciences , Via Massarenti, 9, 40138 Bologna , Italy
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KASL clinical practice guidelines: management of hepatitis C. Clin Mol Hepatol 2014; 20:89-136. [PMID: 25032178 PMCID: PMC4099340 DOI: 10.3350/cmh.2014.20.2.89] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 05/20/2014] [Indexed: 12/16/2022] Open
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Melo LODR, Monteiro DLM, Rodrigues NCP. Factors associated with treatment interruption for Hepatitis C. Rev Assoc Med Bras (1992) 2014; 60:29-34. [PMID: 24918849 DOI: 10.1590/1806-9282.60.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 01/07/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate risk factors related to Hepatitis C treatment interruption. METHODS Retrospective cohort of patients seen at the Hepatology outpatient service at Hospital dos Servidores do Estado do Rio de Janeiro, from 2001 to 2009. The factors investigated were: age, gender, genotype, degree of liver fibrosis, type of treatment, treatment time in weeks, diabetes mellitus, and systemic hypertension. Survival curves and bivariate and multivariate Cox regression models were used in the analyses. RESULTS The risk of treatment interruption is six times greater in patients with more advanced degrees of liver fibrosis (F4) compared to those with less advanced degree (F2) in the period from 0 to 24 weeks of treatment. Genotype was found to be an important factor to explain therapy cessation after 24 weeks of treatment - the risk of stopping treatment was 2.5 times higher in patients with genotype 3 than in those with genotype 1. CONCLUSION Degree of liver fibrosis and genotype proved to be the main risk factors associated to treatment interruption.
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Afzal MS, Anjum S, Zaidi NUSS. Changing of HCV clade pattern in iran; the possible means for something good. HEPATITIS MONTHLY 2014; 14:e11879. [PMID: 24497875 PMCID: PMC3909638 DOI: 10.5812/hepatmon.11879] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/01/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Muhammad Sohail Afzal
- Atta ur Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan
- Corresponding Author: Muhammad Sohail Afzal, Atta ur Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan. Tel: +92-3215244808, Fax: +92-5190856102, E-mail:
| | - Sadia Anjum
- Atta ur Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan
| | - Najam us Sahar Sadaf Zaidi
- Atta ur Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan
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Zhou H, Luo H, Xiao S, Wang H, Gong G. Predictors for dose reduction of antiviral therapy in older patients infected with hepatitis C virus: a meta-regression analysis. Eur J Clin Microbiol Infect Dis 2013; 33:491-8. [PMID: 24193376 DOI: 10.1007/s10096-013-1992-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 09/30/2013] [Indexed: 01/19/2023]
Abstract
Treatment-related adverse events (AE) were more frequent in older patients treated by pegylated interferon (PEG-IFN) plus ribavirin (RBV) for chronic hepatitis C (CHC), and most of them required dose reduction. A meta-regression analysis was conducted to explore the possible reasons for this occurrence. We searched MEDLINE, EMBASE, and Web of Science through May 2013, for clinical trials examining the safety of PEG-IFN plus RBV in elderly patients with CHC. Data were extracted for host, viral, and outcome information. Single-arm meta-analysis was performed to evaluate AE. Meta-regression analysis was conducted to explore predictors for dose reduction secondary to AE. Eighteen observational studies met the inclusion criteria. The overall incidences of AE were 61.3%. Dose reductions due to AE were 54.2%. In patients with genotype 1, the rate of sustained virological response (SVR) was 36.9%. In patients with genotypes 2 or 3, the rate of SVR was 72.8%. Patients with more dose reduction due to AE have a tendency toward a lower likelihood of obtaining SVR (coefficient:-0.529), especially for genotype 1 patients. Host factors (male gender, coefficient 4.403; higher body weight, coefficient 0.140; and advanced fibrosis stage, coefficient 1.582) and viral factors (HCV genotype 1, coefficient 2.279) have a significant impact on dose reduction due to AE. Some host and viral factors affected dose reduction due to AE. Increasing rates of fibrosis with age may play a role as a mechanism affecting dose reduction secondary to AE and SVR in different age groups.
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Affiliation(s)
- H Zhou
- Department of Infectious Diseases, the Second Xiangya Hospital, Central South University, 139 Renming Middle Road, Changsha, Hunan Province, 410011, China
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