Barriers to treatment of failed or interferon ineligible patients in the era of DAA: single center study
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Interferon-based treatment is not appropriate for a large number of patients with chronic hepatitis C for various medical and social reasons. Newly developed directly acting antivirals (DAAs) have been used to treat chronic hepatitis C without severe adverse effects and have achieved a sustained viral response (SVR) rate of 80-90% with short treatment duration. We were interested to determine whether all patients who failed to respond to or were ineligible for interferon-based therapy could be treated with DAAs. Methods: Medical records of patients with positive serum anti-hepatitis C virus (HCV) or HCV RNA between January 2009 and December 2013 were reviewed. Demographic, clinical, and treatment data were collected for analysis. Results: A total of 876 patients were positive for both anti-HCV and HCV RNA. Of these, 244 patients were eligible for interferon, although this was associated with relapse in 39 (16%) of patients. In total, 130 patients stopped interferon therapy (67% adverse effects, 28% non-adherent, 4% malignancy, 1% alcohol abuse) and 502 patients were ineligible (66% medical contraindications, 25% non-adherent, 5% socioeconomic problems). Among 671 patients who were ineligible for or failed to respond to interferon therapy, more than 186 (27.7%) could not be treated with DAA due to financial, social, or cancer-related conditions. Conclusions: Newly developed DAAs are a promising treatment for patients with chronic hepatitis C who are ineligible for or failed to respond to interferon-based therapy. Nevertheless, not all chronic hepatitis C patients can be treated with DAAs due to various reasons.
Abstract
Background/Aims: Interferon-based treatment is not appropriate for a large number of patients with chronic hepatitis C for various medical and social reasons. Newly developed directly acting antivirals (DAAs) have been used to treat chronic hepatitis C without severe adverse effects and have achieved a sustained viral response (SVR) rate of 80-90% with short treatment duration. We were interested to determine whether all patients who failed to respond to or were ineligible for interferon-based therapy could be treated with DAAs. Methods: Medical records of patients with positive serum anti-hepatitis C virus (HCV) or HCV RNA between January 2009 and December 2013 were reviewed. Demographic, clinical, and treatment data were collected for analysis. Results: A total of 876 patients were positive for both anti-HCV and HCV RNA. Of these, 244 patients were eligible for interferon, although this was associated with relapse in 39 (16%) of patients. In total, 130 patients stopped interferon therapy (67% adverse effects, 28% non-adherent, 4% malignancy, 1% alcohol abuse) and 502 patients were ineligible (66% medical contraindications, 25% non-adherent, 5% socioeconomic problems). Among 671 patients who were ineligible for or failed to respond to interferon therapy, more than 186 (27.7%) could not be treated with DAA due to financial, social, or cancer-related conditions. Conclusions: Newly developed DAAs are a promising treatment for patients with chronic hepatitis C who are ineligible for or failed to respond to interferon-based therapy. Nevertheless, not all chronic hepatitis C patients can be treated with DAAs due to various reasons.
참고문헌 (17)
- Pawlotsky JM, "From non-A, non-B hepatitis to hepatitis C virus cure", J Hepatol, 62(1 Suppl), pp.S87~S99 (2015)
- Fried MW, "Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection", N Engl J Med, 347, pp.975~982 (2002)
- 박상훈, "Efficacy and Tolerability of Peginterferon Alpha Plus Ribavirin in the Routine Daily Treatment of Chronic Hepatitis C Patients in Korea: A Multi-Center, Retrospective Observational Study", Gut and Liver, 6(1), pp.98~106 (2012), 거트앤리버 발행위원회
- Falck-Ytter Y, "Surprisingly small effect of antiviral treatment in patients with hepatitis C", Ann Intern Med, 136, pp.288~292 (2002)
- Cox AL, "MEDICINE. Global control of hepatitis C virus", Science, 349, pp.790~791 (2015)
- Korean Association for the Study of the Liver, "KASL clinical practice guidelines: management of hepatitis C", Clin Mol Hepatol, 22, pp.76~139 (2016)
- Seong MH, "Clinical and epidemiological features of hepatitis C virus infection in South Korea: a prospective, multicenter cohort study", J Med Virol, 85, pp.1724~1733 (2013)
- European Association for Study of Liver, "EASL recommendations on treatment of hepatitis C 2015", J Hepatol, 63, pp.199~236 (2015)
- Prasad L, "Cohort profile: the Swiss Hepatitis C Cohort Study (SCCS)", Int J Epidemiol, 36, pp.731~737 (2007)
- Hansen N, "Predictors of antiviral treatment initiation in hepatitis C virus-infected patients: a Danish cohort study", J Viral Hepat, 16, pp.659~665 (2009)
- Narasimhan G, "Treatment rates in patients with chronic hepatitis C after liver biopsy", J Viral Hepat, 13, pp.783~786 (2006)
- Restrepo A, "The rate of treatment of chronic hepatitis C in patients co-infected with HIV in an urban medical centre", J Viral Hepat, 12, pp.86~90 (2005)
- Singal AK, "Meta-analysis: interferon improves outcomes following ablation or resection of hepatocellular carcinoma", Aliment Pharmacol Ther, 32, pp.851~858 (2010)
- Conti F, "Early occurrence and recurrence of hepatocellular carcinoma in HCV-related cirrhosis treated with direct-acting antivirals", J Hepatol, 65, pp.727~733 (2016)
- Reig M, "Unexpected high rate of early tumor recurrence in patients with HCV-related HCC undergoing interferon-free therapy", J Hepatol, 65, pp.719~726 (2016)
- Majumdar A, "Systematic review: current concepts and challenges for the direct-acting antiviral era in hepatitis C cirrhosis", Aliment Pharmacol Ther, 43, pp.1276~1292 (2016)
- Kim DY, "A nationwide seroepidemiology of hepatitis C virus infection in South Korea", Liver Int, 33, pp.586~594 (2013)