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Younossi ZM, Yu ML, El-Kassas M, Esmat G, Castellanos Fernández MI, Buti M, Papatheodoridis G, Yilmaz Y, Isakov V, Duseja A, Méndez-Sánchez N, Hamid S, Gordon SC, Romero-Gómez M, Chan WK, Ong JP, Younossi I, Lam B, Ziayee M, Nader F, Racila A, Henry L, Stepanova M. Severe impairment of patient-reported outcomes in patients with chronic hepatitis C virus infection seen in real-world practices across the world: Data from the global liver registry. J Viral Hepat 2022; 29:1015-1025. [PMID: 36036096 DOI: 10.1111/jvh.13741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 12/09/2022]
Abstract
Cure of chronic hepatitis C (CHC) can lead to improvement of health-related quality of life and other patient-reported outcomes (PROs). While extensive PRO data for CHC patients who were enrolled in clinical trials are available, similar data for patients seen in real-world practices are scarce. Our aim was to assess PROs of CHC patients enrolled from real-world practices from different regions and to compare them with those enrolled in clinical trials. CHC patients seen in clinical practices and not receiving treatment were enrolled in the Global Liver Registry (GLR). Clinical and PRO (FACIT-F, CLDQ-HCV, WPAI) data were collected and compared with the baseline data from CHC patients enrolled in clinical trials. N = 12,171 CHC patients were included (GLR n = 3146, clinical trial subjects n = 9025). Patients were from 30 countries from 6 out of 7 Global Burden of Disease (GBD) super-regions. Compared with clinical trial enrollees, patients from GLR were less commonly enrolled from High-Income GBD super-region, older, more commonly female, less employed, had more type 2 diabetes, anxiety and clinically overt fatigue but less cirrhosis (all p < 0.001). Out of 15 PRO domain and summary scores, 12 were lower in GLR patients than in subjects enrolled in clinical trials (p < 0.001). In multiple regression models, anxiety, depression, and fatigue were associated with significant PRO impairment in CHC patients (p < 0.05). After adjustment for the clinico-demographic confounders, the association of PRO scores of CHC patients with enrolment settings was no longer significant (all p > 0.05). In conclusion, hepatitis C patients seen in the real-world practices have PRO impairment driven by fatigue and psychiatric comorbidities.
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Affiliation(s)
- Zobair M Younossi
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Beatty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Medicine, Kaohsiung Medical University Hospital; Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Mohamed El-Kassas
- Endemic Medicine and Hepato-Gastroenterology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Gamal Esmat
- Endemic Medicine Department, Cairo University Hospitals, Cairo, Egypt
| | | | - Maria Buti
- Liver Unit Vall d'Hebron University Hospital, and CIBEREHD del Instituto Carlos III Barcelona, Barcelona, Spain
| | | | - Yusuf Yilmaz
- Institute of Gastroenterology, Marmara University, Istanbul, Turkey.,Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Vasily Isakov
- Gastroenterology and Hepatology at Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow, Russia
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nahum Méndez-Sánchez
- Medica Sur Clinic and Foundation, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Saeed Hamid
- Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Stuart C Gordon
- Department of Gastroenterology, Henry Ford Health Systems, Detroit, Michigan, USA
| | - Manuel Romero-Gómez
- Digestive Diseases Department and CIBEREHD, Virgen del Rocío University Hospital. Institute of Biomedicine of Seville (HUVR/CSIC/US). University of Seville, Seville, Spain
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Janus P Ong
- College of Medicine, University of Philippines, Manila, Philippines
| | - Issah Younossi
- Center for Outcomes Research in Liver Diseases, Washington, Columbia, USA
| | - Brain Lam
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Beatty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
| | - Mariam Ziayee
- Center for Outcomes Research in Liver Diseases, Washington, Columbia, USA
| | - Fatema Nader
- Center for Outcomes Research in Liver Diseases, Washington, Columbia, USA
| | - Andrei Racila
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Medical Campus, Falls Church, Virginia, USA.,Beatty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
| | - Linda Henry
- Center for Outcomes Research in Liver Diseases, Washington, Columbia, USA
| | - Maria Stepanova
- Center for Outcomes Research in Liver Diseases, Washington, Columbia, USA
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Dalgard O, Litwin AH, Shibolet O, Grebely J, Nahass R, Altice FL, Conway B, Gane EJ, Luetkemeyer AF, Peng CY, Iser D, Gendrano IN, Kelly MM, Haber BA, Platt H, Puenpatom A. Health-related quality of life in people receiving opioid agonist treatment and treatment for hepatitis C virus infection. J Addict Dis 2022:1-12. [PMID: 35920743 DOI: 10.1080/10550887.2022.2088978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND In people with chronic hepatitis C virus (HCV) infection, viral eradication is associated with improved health-related quality of life (HRQOL). OBJECTIVE To assess changes in HRQOL among participants receiving opioid agonist therapy undergoing treatment for HCV infection. METHODS COSTAR (NCT02251990) was a randomized, double-blind, placebo-controlled study. Adults with HCV infection on opioid agonist therapy received elbasvir (50 mg)/grazoprevir (100 mg) or placebo for 12 weeks. HRQOL was evaluated using the Medical Outcomes Study 36-Item Short Form Health Survey version 2 (SF-36v2) Acute Form. Participants remained blinded until 4 weeks after end of treatment. RESULTS Overall, 201 participants received elbasvir/grazoprevir and 100 participants received placebo. Treatment difference mean change from baseline scores (elbasvir/grazoprevir minus placebo) indicated an improvement in HRQOL at 4 weeks after end of treatment in participants receiving elbasvir/grazoprevir versus those receiving placebo, driven by declining HRQOL in those receiving placebo and improved HRQOL in certain domains among participants receiving elbasvir/grazoprevir. Notable differences in SF-36v2 scores were evident in the general health (mean treatment difference [MTD], 6.00; 95% CI, 1.37-10.63), vitality (MTD, 6.81; 95% CI, 1.88-11.75), and mental health (MTD, 5.17; 95% CI, 0.52-9.82) domains and in the mental component summary score (mean, 2.83; 95% CI, 0.29-5.37). No notable between-treatment differences were evident at treatment weeks 4 or 12. CONCLUSION HRQOL in patients receiving medication for opioid dependence was improved following treatment for HCV infection with elbasvir/grazoprevir, suggesting that eradication of HCV infection with direct-acting antivirals is associated with improved HRQOL. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT02251990.
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Affiliation(s)
- Olav Dalgard
- Institute of Clinical Medicine, Akershus University, Oslo, Norway
| | - Alain H Litwin
- Prisma Health/University of South Carolina School of Medicine Greenville, Clemson University, Greenville, SC, USA
| | - Oren Shibolet
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | | | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | | | | | | | - David Iser
- The Alfred Hospital, Melbourne, VIC, Australia
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3
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Sakamori R, Yamada R, Shinkai K, Doi A, Tahata Y, Shigekawa M, Kodama T, Hikita H, Yamada T, Tatsumi T, Takehara T. Improvement of Skeletal Muscle Mass after Ledipasvir and Sofosbuvir Treatment for Hepatitis C Virus in Decompensated Liver Cirrhosis. Intern Med 2021; 60:745-750. [PMID: 33642562 PMCID: PMC7990635 DOI: 10.2169/internalmedicine.6029-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hepatitis C virus (HCV) can be eliminated by direct-acting antivirals in patients with decompensated liver cirrhosis. Although viral clearance in decompensated liver cirrhosis leads to improvement of the liver function and quality of life, changes in the skeletal muscle mass after sustained virologic response (SVR) in patients with decompensated liver cirrhosis have not been reported. We present the first report of skeletal muscle mass improvement with the achievement of SVR for HCV in a 76-year-old woman with decompensated liver cirrhosis. After achieving SVR through ledipasvir/sofosbuvir treatment, the patient showed an improvement in her liver function and an increase in her skeletal muscle mass.
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Affiliation(s)
- Ryotaro Sakamori
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Ryoko Yamada
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Kazuma Shinkai
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Akira Doi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Yuki Tahata
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Minoru Shigekawa
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Takahiro Kodama
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Hayato Hikita
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital, Japan
| | - Tomohide Tatsumi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Japan
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Parmar P, Shafran SD, Borgia SM, Doucette K, Cooper CL. Hepatitis C direct-acting antiviral outcomes in patients 75 years and older. JGH OPEN 2020; 5:253-257. [PMID: 33553664 PMCID: PMC7857276 DOI: 10.1002/jgh3.12480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022]
Abstract
Background and Aim Elderly patients with hepatitis C virus (HCV) infection have worse interferon‐based treatment outcomes than young patients. Direct‐acting antiviral (DAA) regimens have enabled the treatment of previously difficult‐to‐cure populations. There are few studies that specifically assess DAA treatment outcomes in patients over 75 years of age. Methods Design: This was a cohort study. Setting: The setting was three Canadian HCV specialty sites. Participants: Patients aged 75 years and older and treated with DAA without interferon were enrolled. Measurements: Patient demographics, liver fibrosis by transient elastography, treatment regimen, and treatment outcome data were collected. Results The mean age of 78 patients in our analysis was 78.6 years (SD 3.5; range: 75–88 years). The most common genotype was 1b (35%). The most frequently utilized regimens included sofosbuvir‐velpatasvir (33%) and ledipasvir‐sofosbuvir (32%). Ribavirin was included for 17% of recipients. Sustained virological response (SVR) was achieved in 94% of patients (69% of those receiving ribavirin and 98% of patients on ribavirin‐free regimens). Ribavirin toxicity contributed to the lower SVR rates in ribavirin‐exposed patients. Ribavirin dosage was decreased in three patients and ultimately discontinued in two of these patients. All treatment was discontinued in another two patients. Conclusion Ribavirin‐free DAA therapy is safe and achieves SVR rates in older adults comparable to those described in the general population. RBV inclusion frequently results in complications, often leads to treatment modification or interruption, and does not improve SVR rates in those with advanced age.
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Affiliation(s)
- Parmvir Parmar
- Department of Medicine University of Ottawa Ottawa Ontario Canada.,The Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Stephen D Shafran
- Department of Medicine University of Alberta Edmonton Alberta Canada
| | - Sergio M Borgia
- William Osler Health Centre Brampton Civic Hospital Brampton Ontario Canada
| | - Karen Doucette
- Department of Medicine University of Alberta Edmonton Alberta Canada
| | - Curtis L Cooper
- Department of Medicine University of Ottawa Ottawa Ontario Canada.,The Ottawa Hospital Research Institute Ottawa Ontario Canada
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5
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Schulte B, Schmidt CS, Manthey J, Strada L, Christensen S, Cimander K, Görne H, Khaykin P, Scherbaum N, Walcher S, Mauss S, Schäfer I, Verthein U, Rehm J, Reimer J. Clinical and Patient-Reported Outcomes of Direct-Acting Antivirals for the Treatment of Chronic Hepatitis C Among Patients on Opioid Agonist Treatment: A Real-world Prospective Cohort Study. Open Forum Infect Dis 2020; 7:ofaa317. [PMID: 32875003 PMCID: PMC7452367 DOI: 10.1093/ofid/ofaa317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background Patient-reported outcomes (PROs) can help to reduce uncertainties about hepatitis C virus (HCV) treatment with direct-acting antivirals (DAAs) among people who inject drugs and increase treatment uptake in this high-risk group. Besides clinical data, this study analyzed for the first time PROs in a real-world sample of patients on opioid agonist treatment (OAT) and HCV treatment with DAAs. Methods HCV treatment data including virological response, adherence, safety, and PROs of 328 German patients on OAT were analyzed in a pragmatic prospective cohort study conducted from 2016 to 2018. Clinical effectiveness was defined as sustained virological response (SVR) at week 12 after end of treatment and calculated in per-protocol (PP) and intention-to-treat (ITT) analyses. Changes over time in PROs on health-related quality of life, physical and mental health, functioning, medication tolerability, fatigue, concentration, and memory were analyzed by repeated-measures analyses of variances (ANOVAs). Results We found high adherence and treatment completion rates, a low number of mainly mild adverse events, and high SVR rates (PP: 97.5% [n = 285]; ITT: 84.5% [n = 328]). Missing SVR data in the ITT sample were mainly caused by patients lost to follow-up after treatment completion. Most PROs showed statistically significant but modest improvements over time, with more pronounced improvements in highly impaired patients. Conclusions This real-world study confirms that DAA treatment among OAT patients is feasible, safe, and effective. PROs show that all patients, but particularly those with higher somatic, mental, and social burden, benefit from DAA treatment.
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Affiliation(s)
- Bernd Schulte
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane S Schmidt
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Manthey
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Lisa Strada
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Christensen
- Center for Interdisciplinary Medicine Infectious Diseases, Muenster, Germany.,Department of Gastroenterology and Hepatology, Muenster University Hospital, Muenster, Germany
| | - Konrad Cimander
- Kompetenzzentrum Suchtmedizin, Infektiologie und Cannabis-Therapie, Hannover, Germany
| | - Herbert Görne
- MediZentrum Hamburg, Praxis für Suchtmedizin, Hamburg, Germany
| | | | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, Department of Psychiatry, Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Gesundheit Nord, Bremen, Germany
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Sustained Improvements in Markers of Liver Disease Severity After Hepatitis C Treatment. J Clin Exp Hepatol 2020; 10:114-123. [PMID: 32189926 PMCID: PMC7068013 DOI: 10.1016/j.jceh.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND & AIMS Although serological markers of disease severity improve after hepatitis C virus (HCV) treatment, it is unclear if all patients experience sustained improvement. We aim to evaluate longitudinal changes in aspartate (AST), alanine (ALT) aminotransferase, platelet count (PLT), and fibrosis-4 (FIB-4) after HCV treatment. METHODS All adult chronic HCV patients who received antiviral therapy from January 2011 to February 2017 at four large urban hospital systems were evaluated to assess changes in AST, ALT, PLT, and FIB-4 from pre-treatment to post-treatment annually up to 4 years after HCV therapy. Comparisons used Student's t-test and analysis of variance, and were stratified by sex, race, ethnicity, age, body mass index (BMI), and diabetes mellitus. RESULTS Among 2691 patients (62.2% men, 76.9% aged 45-65 years, 56.5% white), all markers of disease severity demonstrated sustained improvements from pre-treatment to 4 years post-treatment (AST 53 U/L to 27.5 U/L, ALT 53 U/L to 29 U/L, PLT 168 × 103 to 176 × 103, FIB-4 2.51 to 1.68). However, Hispanics and patients with BMI >30 kg/m2 experienced rebound increases in AST, ALT, and FIB-4 at 4 years post-treatment after experiencing initial improvements in these serological markers in the first-year post-treatment. Sustained improvements in PLT were observed in all groups, including Hispanics and patients with BMI >30 kg/m2. CONCLUSION HCV treatment in a large community-based cohort demonstrated sustained improvements in AST, ALT, PLT, and FIB-4. Rebound increases in AST, ALT, and FIB-4 observed in Hispanics and those with BMI >30 kg/m2 may reflect persisting nonalcoholic fatty liver disease.
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7
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Younossi ZM, Stepanova M, Anstee QM, Lawitz EJ, Wai-Sun Wong V, Romero-Gomez M, Kersey K, Li G, Subramanian GM, Myers RP, Djedjos CS, Okanoue T, Trauner M, Goodman Z, Harrison SA. Reduced Patient-Reported Outcome Scores Associate With Level of Fibrosis in Patients With Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol 2019; 17:2552-2560.e10. [PMID: 30779990 DOI: 10.1016/j.cgh.2019.02.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are used to measure patients' experience with their disease. However, there are few PRO data from patients with NASH. We collected data from the STELLAR clinical trials to assess PROs for NASH and advanced fibrosis. METHODS We analyzed data from 1667 patients (58 ± 9 years, 40% male, 52% with cirrhosis, 74% with diabetes) with NASH and bridging fibrosis or compensated cirrhosis (metavir scores, F3 or F4) enrolled in the phase 3 STELLAR trials of selonsertib (NCT03053050 and NCT03053063) who completed PRO questionnaires (SF-36, CLDQ-NASH, EQ-5D, or WPAI:SHP) before treatment initiation. RESULTS Compared with patients with F3 fibrosis, higher proportions of patients with F4 fibrosis were female, were white, had more hematologic and gastrointestinal comorbidities, and had type 2 diabetes (P ≤ .01). Mean physical health-related PRO scores were significantly lower than those of the general population: patients with F4 fibrosis had score reductions of 4.4% to 12.9% in 6/8 SF-36 domains and patients with F3 fibrosis had score reductions of 3.9% to 11.7% in 4/8 domains (P < .01). Compared to patients with F3 fibrosis, those with F4 fibrosis had lower scores in all but 1 domains of CLDQ-NASH, Role Physical, Bodily Pain, and Social Functioning domains of the SF-36, and EQ-5D (P ≤ 01). In multivariate regression analysis, factors independently associated with lower PRO scores included having cirrhosis, female sex, higher body mass index, history of smoking, and diabetes or other comorbidities (P < .01). CONCLUSIONS PROs are significantly lower in patients with NASH with advanced fibrosis who participated in the STELLAR clinical trials. Treatment of patients with NASH should focus on improving not only clinical outcomes but also quantifiable symptom burden and health-related quality of life.
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Affiliation(s)
- Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia.
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease (COR-LD), Washington, District of Columbia
| | - Quentin M Anstee
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle-upon-Tyne, and Newcastle NIHR Biomedical Research Centre, Newcastle-upon-Tyne, United Kingdom
| | - Eric J Lawitz
- Texas Liver Institute, University of Texas Health San Antonio, San Antonio, Texas
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong
| | | | | | - Georgia Li
- Gilead Sciences, Inc, Foster City, California
| | | | | | | | | | - Michael Trauner
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Zachary Goodman
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia; Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia
| | - Stephen A Harrison
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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8
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Montague S, Agarwal K, Cannon M. Exploring the emotions of patients undergoing therapy for hepatitis C. ACTA ACUST UNITED AC 2019; 28:824-828. [PMID: 31303036 DOI: 10.12968/bjon.2019.28.13.824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND direct-acting antiviral (DAA) therapy is highly efficacious in the treatment of hepatitis C (HCV). The literature to date has focused primarily on the physical health benefits of viral eradication. AIMS this study explored patient emotions during and after DAA therapy for HCV. METHODS over a 6-month period, 178 patients attending a viral hepatitis clinic for treatment of HCV were posed a single question: 'How do you feel about your diagnosis of hepatitis C today?' Responses were transcribed verbatim, thematically coded and visualised using WordArt software. FINDINGS the images depict the evolution of patients' perceptions of HCV before, during and after DAA therapy. Responses before treatment were predominantly negative, often describing the fear of contagion and feelings of isolation, secrecy and loneliness. After treatment, patients often described feeling positive and more motivated. CONCLUSIONS the results demonstrate that treatment of HCV has a transformative effect on patients' perception of the impact of HCV on their wellbeing. This may promote a more positive outlook and, in turn, facilitate patient engagement with healthcare.
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Affiliation(s)
- Sarah Montague
- Biomedical Research Associate, Institute of Liver Studies, London
| | - Kosh Agarwal
- Consultant Hepatologist and Transplant Physician, Institute of Liver Studies, London
| | - Mary Cannon
- Consultant Hepatologist, Institute of Liver Studies, London
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9
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Patients With Nonalcoholic Steatohepatitis Experience Severe Impairment of Health-Related Quality of Life. Am J Gastroenterol 2019; 114:1636-1641. [PMID: 31464743 DOI: 10.14309/ajg.0000000000000375] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Although there is substantial evidence suggesting poor health-related quality of life (HRQL) in patients with chronic hepatitis C (CHC), similar data in nonalcoholic steatohepatitis (NASH) have not been fully assessed. The aim is to compare HRQL scores in patients with CHC to those with NASH. METHODS Matched patients with advanced fibrosis (bridging fibrosis and compensated cirrhosis) due to CHC and NASH completed Short Form-36 (SF-36) questionnaire, Chronic Liver Disease Questionnaire (CLDQ), and Work Productivity and Activity Instrument questionnaire. RESULTS We included 1,338 patients with NASH with advanced fibrosis (mean age 57.2 years, 47% men, 55% cirrhosis) and 1,338 matched patients with CHC. Patients with CHC and NASH had similar rates of employment and psychiatric disorders (P > 0.05). As expected, patients with NASH had higher body mass index (mean 33.7 vs 27.6) and more type 2 diabetes (74% vs 16%) (all P < 0.01). Patients with NASH had significantly lower HRQL scores related to physical health: Physical Functioning, Bodily Pain, General Health, Vitality, Physical Summary of SF-36, and Fatigue of CLDQ (P < 0.02). By contrast, patients with CHC had a lower Mental Health score of SF-36 and Emotional score of CLDQ and reported greater impairment in daily activities as measured by the Work Productivity and Activity Instrument questionnaire (P < 0.002). In multivariate analysis, after adjustment for demographic parameters, cirrhosis, and history of psychiatric disorders, having NASH was associated with lower physical HRQL scores and higher mental health-related scores (P < 0.05). DISCUSSION Patients with NASH and advanced fibrosis have more impairment of their physical health-related scores than patients with CHC with advanced fibrosis. These data should dispel the misconception that NASH is an asymptomatic disease with little negative impact on patients' well-being.
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10
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de Avila L, Weinstein AA, Estep JM, Curry MP, Golabi P, Escheik C, Birerdinc A, Stepanova M, Gerber L, Younossi ZM. Cytokine balance is restored as patient-reported outcomes improve in patients recovering from chronic hepatitis C. Liver Int 2019; 39:1631-1640. [PMID: 30959554 DOI: 10.1111/liv.14115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/21/2019] [Accepted: 04/02/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Chronic hepatitis C (CHC) has a negative impact on patient-reported outcomes (PROs). Although most CHC patients who achieve sustained virologic response (SVR) show an improvement in PRO scores, some continue to experience impairment in PROs. The aim was to investigate if serum biomarkers (selected neurotransmitters and cytokines) are associated with changes in PROs in CHC patients who achieve SVR. METHODS Data were utilized from a prospective clinical trial of ledipasvir/sofosbuvir fixed-dose combination. Chronic genotype 1 HCV subjects without cirrhosis (N = 40, age: 45.3 ± 11.5, 48% male, 90% white) were treated for 12 weeks open label with 97% achieving SVR24. PRO questionnaires included Short Form-36 (SF-36), Fatigue Severity Scale (FSS), Beck Depression Inventory-II (BDI-II), Chronic Liver Disease Questionnaire-HCV (CLDQ-HCV) and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Sera were used for measurement of selected neurotransmitters and cytokines. Data were collected at baseline and follow-up week 24. RESULTS Changes in physical health correlated with changes in several biomarkers. BDNF negatively correlated with SF-36 physical health summary score (rho = -0.34, P < 0.05), SF-36 physical functioning (rho = -0.34, P < 0.05), SF-36 bodily pain (rho = -0.39, P < 0.05) and FACIT-F physical well-being (rho = -0.54, P < 0.001). Changes in emotional well-being (FACIT-F) were positively associated with changes in serotonin (rho = 0.34, P < 0.05), but negatively associated with changes in GABA and BDNF (rho = -0.4, P = 0.01, and rho = -0.35, P < 0.05 respectively). CONCLUSIONS These data indicate relationships between PROs and serum biomarkers pre- and post-SVR in CHC. These concomitant changes may have important clinical relevance.
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Affiliation(s)
- Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Ali A Weinstein
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.,Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia
| | - J Michael Estep
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | | | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Carey Escheik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Aybike Birerdinc
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Maria Stepanova
- Center for Outcomes Research in Liver Diseases, Washington, District of Columbia
| | - Lynn Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.,Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia
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11
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Childs-Kean LM, Brumwell NA, Lodl EF. Profile of sofosbuvir/velpatasvir/voxilaprevir in the treatment of hepatitis C. Infect Drug Resist 2019; 12:2259-2268. [PMID: 31413603 PMCID: PMC6662169 DOI: 10.2147/idr.s171338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/23/2019] [Indexed: 12/20/2022] Open
Abstract
The treatment of chronic hepatitis C has been revolutionized with the introduction of direct-acting antivirals (DAAs). However, some patients are not cured with first-line treatment. Sofosbuvir/velpatasvir/voxilaprevir is a fixed-dose combination of a polymerase inhibitor, an NS5A inhibitor, and a protease inhibitor with activity against strains of the hepatitis C virus that show resistance to other first-line antiviral regimens. Sofosbuvir/velpatasvir/voxilaprevir has been studied in four Phase III randomized trials: POLARIS-1, −2, −3, and −4, which enrolled both treatment naïve and experienced patients with and without compensated cirrhosis. In these trials, at least 95% of patients treated with sofosbuvir/velpatasvir/voxilaprevir achieved sustained virological response (SVR). This includes favorable treatment outcomes in patients who had previously failed a regimen containing sofosbuvir or an NS5A inhibitor. Patient-reported outcomes also improved during and after treatment with sofosbuvir/velpatasvir/voxilaprevir. Treatment with sofosbuvir/velpatasvir/voxilaprevir is well tolerated, with the most commonly reported adverse events being headache, fatigue, diarrhea, and nausea. The approval of sofosbuvir/velpatasvir/voxilaprevir allows a treatment option for patients who have failed treatment with certain DAA regimens.
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Affiliation(s)
- Lindsey M Childs-Kean
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Natalie A Brumwell
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Emma F Lodl
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
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12
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Herink MC, Irwin AN, Zumach GM. FDA Breakthrough Therapy Designation: Evaluating the Quality of the Evidence behind the Drug Approvals. Pharmacotherapy 2019; 38:967-980. [PMID: 30043413 DOI: 10.1002/phar.2167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The United States Food and Drug Administration (FDA) has created approval pathways and designations to accelerate access to medications indicated for serious or life-threatening conditions with limited treatment options. Implemented in 2012, the most recent of these is the breakthrough therapy designation (BTD). The purpose of this article was to review the evidence surrounding approval of medications with nononcology indications approved with the BTD designation from 2012 to 2016. Fifteen medications were identified for eight conditions, ranging from conditions that are relatively common, such as chronic hepatitis C infection, to those that are extremely rare, such as lysosomal acid lipase deficiency. The quality of evidence behind these approvals was highly heterogeneous. Much remains unknown about the safety and efficacy of many agents approved through the BTD. Health care professionals should be aware of these limitations to better educate patients and other providers appropriately.
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Affiliation(s)
- Megan C Herink
- Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Portland, Oregon
| | - Adriane N Irwin
- Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Corvallis, Oregon
| | - Gregory M Zumach
- Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy, Corvallis, Oregon
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13
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Davis C, Mgomella GS, da Silva Filipe A, Frost EH, Giroux G, Hughes J, Hogan C, Kaleebu P, Asiki G, McLauchlan J, Niebel M, Ocama P, Pomila C, Pybus OG, Pépin J, Simmonds P, Singer JB, Sreenu VB, Wekesa C, Young EH, Murphy DG, Sandhu M, Thomson EC. Highly Diverse Hepatitis C Strains Detected in Sub-Saharan Africa Have Unknown Susceptibility to Direct-Acting Antiviral Treatments. Hepatology 2019; 69:1426-1441. [PMID: 30387174 PMCID: PMC6492010 DOI: 10.1002/hep.30342] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/30/2018] [Indexed: 12/11/2022]
Abstract
The global plan to eradicate hepatitis C virus (HCV) led by the World Health Organization outlines the use of highly effective direct-acting antiviral drugs (DAAs) to achieve elimination by 2030. Identifying individuals with active disease and investigation of the breadth of diversity of the virus in sub-Saharan Africa (SSA) is essential as genotypes in this region (where very few clinical trials have been carried out) are distinct from those found in other parts of the world. We undertook a population-based, nested case-control study in Uganda and obtained additional samples from the Democratic Republic of Congo (DRC) to estimate the prevalence of HCV, assess strategies for disease detection using serological and molecular techniques, and characterize genetic diversity of the virus. Using next-generation and Sanger sequencing, we aimed to identify strains circulating in East and Central Africa. A total of 7,751 Ugandan patients were initially screened for HCV, and 20 PCR-positive samples were obtained for sequencing. Serological assays were found to vary significantly in specificity for HCV. HCV strains detected in Uganda included genotype (g) 4k, g4p, g4q, and g4s and a newly identified unassigned g7 HCV strain. Two additional unassigned g7 strains were identified in patients originating from DRC (one partial and one full open reading frame sequence). These g4 and g7 strains contain nonstructural (ns) protein 3 and 5A polymorphisms associated with resistance to DAAs in other genotypes. Clinical studies are therefore indicated to investigate treatment response in infected patients. Conclusion: Although HCV prevalence and genotypes have been well characterized in patients in well-resourced countries, clinical trials are urgently required in SSA, where highly diverse g4 and g7 strains circulate.
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Affiliation(s)
- Chris Davis
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - George S. Mgomella
- Department of Medicine ‐ University of CambridgeCambridgeCambridgeshireUnited Kingdom
- Wellcome Sanger InstituteHinxtonCambridgeshireUnited Kingdom
| | - Ana da Silva Filipe
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | | | | | - Joseph Hughes
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | | | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research UnitEntebbeUganda
- Uganda Virus Research InstituteEntebbeUganda
| | | | - John McLauchlan
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - Marc Niebel
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - Ponsiano Ocama
- Department of MedicineMakerere University College of Health SciencesKampalaUganda
| | - Cristina Pomila
- Department of Medicine ‐ University of CambridgeCambridgeCambridgeshireUnited Kingdom
| | - Oliver G. Pybus
- Department of ZoologyUniversity of OxfordOxfordUnited Kingdom
| | | | - Peter Simmonds
- Peter Medawar Building for Pathogen ResearchUniversity of OxfordUnited Kingdom
| | - Joshua B. Singer
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | - Vattipally B. Sreenu
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
| | | | - Elizabeth H. Young
- Department of Medicine ‐ University of CambridgeCambridgeCambridgeshireUnited Kingdom
- Wellcome Sanger InstituteHinxtonCambridgeshireUnited Kingdom
| | - Donald G. Murphy
- National Institute of Public Health of Quebec, Laboratory of Public Health of QuebecSainte‐Anne‐de‐BellevueQuebecCanada
| | - Manj Sandhu
- Department of Medicine ‐ University of CambridgeCambridgeCambridgeshireUnited Kingdom
- Wellcome Sanger InstituteHinxtonCambridgeshireUnited Kingdom
| | - Emma C. Thomson
- Medical Research Council ‐ University of Glasgow Centre for Virus ResearchGlasgowUnited Kingdom
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14
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Heo YA, Deeks ED. Sofosbuvir/Velpatasvir/Voxilaprevir: A Review in Chronic Hepatitis C. Drugs 2019; 78:577-587. [PMID: 29546556 DOI: 10.1007/s40265-018-0895-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A fixed-dose combination of the hepatitis C virus (HCV) NS5B polymerase inhibitor sofosbuvir, the HCV NS5A inhibitor velpatasvir and the HCV NS3/4A protease inhibitor voxilaprevir (sofosbuvir/velpatasvir/voxilaprevir; Vosevi®) is approved in the EU for the treatment of chronic HCV genotype 1, 2, 3, 4, 5 or 6 infection in adults. In the phase III POLARIS trials, in patients who had HCV genotype 1-6 infection with or without compensated cirrhosis, overall rates of sustained virological response at 12 weeks post-treatment (SVR12) with sofosbuvir/velpatasvir/voxilaprevir were high after 8 weeks of treatment in direct-acting antiviral (DAA)-naïve patients and 12 weeks of treatment in DAA-experienced patients. However, 8 weeks of sofosbuvir/velpatasvir/voxilaprevir was inferior to 12 weeks of sofosbuvir/velpatasvir in cirrhotic or non-cirrhotic DAA-naïve patients with HCV genotype 1, 2, 4, 5 or 6 infection and non-cirrhotic DAA-naïve patients with HCV genotype 3 infection, mostly due to an insufficient treatment period. Sofosbuvir/velpatasvir/voxilaprevir was generally well tolerated, with most adverse events being of mild or moderate intensity. The most common adverse events included headache, fatigue, nausea and diarrhoea. In conclusion, sofosbuvir/velpatasvir/voxilaprevir is an important and effective option for the treatment of HCV genotype 1-6 infection in adults, especially those who have previously failed a DAA therapy with or without an HCV NS5A inhibitor.
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Affiliation(s)
- Young-A Heo
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| | - Emma D Deeks
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
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15
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Kilaru SM, Jacobson IM. Sofosbuvir/velpatasvir/voxilaprevir in the treatment of chronic hepatitis C infection. Future Virol 2019. [DOI: 10.2217/fvl-2018-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The landscape of HCV treatment has been entirely transformed due to the development of direct-acting antivirals (DAAs), but there are limited data guiding salvage therapy in patients who previously failed an NS5A inhibitor-containing DAA regimen. We review the preclinical and clinical data for sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX), an interferon-free, oral, once daily, pan-genotypic treatment for chronic HCV infection. This combination is a highly effective, well-tolerated and safe 12-week treatment regimen for patients with any genotype, including genotype-3 patients with baseline resistance-associated substitutions (RAS). Its most distinctive role is in patients who have previously failed treatment with advanced DAA regimens. Its efficacy is not significantly affected by RASs, and treatment-emergent RASs are uncommon.
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Affiliation(s)
- Saikiran M Kilaru
- Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Ira M Jacobson
- Department of Medicine, New York University School of Medicine, New York, NY 10016, USA
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16
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Younossi ZM, Stepanova M, Reddy R, Manns MP, Bourliere M, Gordon SC, Schiff E, Tran T, Younossi I, Racila A. Viral eradication is required for sustained improvement of patient-reported outcomes in patients with hepatitis C. Liver Int 2019; 39:54-59. [PMID: 29893462 DOI: 10.1111/liv.13900] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Clearance of chronic HCV infection improves quality of life and other patient-reported outcomes (PROs). Lack of placebo-controlled data led to concerns about the extent of contribution of viral eradication to PRO improvement. AIM To assess PRO changes in HCV patients initially randomized to placebo treatment who received SOF/VEL/VOX in a deferred treatment substudy. METHODS HCV-infected direct-acting antivirals-experienced patients who received placebo treatment in POLARIS-1 subsequently received SOF/VEL/VOX (400/100/100 mg) daily for 12 weeks. PROs were prospectively collected using SF-36v2, CLDQ-HCV, FACIT-F, WPAI:SHP. RESULTS Of 147 patients treated, most were male (79%), white (82%), 33% had cirrhosis, 99% had HCV genotype 1 with SVR-12 of 97%. During treatment with placebo, there were no significant changes in any PROs from patients' own baseline (all P > .05) except for the Worry domain of CLDQ-HCV. However, soon after initiation of treatment with SOF/VEL/VOX, significant PRO improvements were noted: +2.4% to +8.1% of a PRO range size, P < .05 for 6 of the 26 studied PROs, by treatment week 4; +2.0% to +8.3%, P < .05 for 14/26 PROs by treatment week 12. Achieving SVR was associated with similar or greater PRO improvement: +2.5% to +11.9%, P < .05 for 24/26 PROs, by SVR-12; +3.2% to +14.9%, P < .05 for 23/26 PROs, by SVR-24. In multivariate regression analysis, being viraemic was associated with PRO impairment: beta from -2.4% to -8.5%, P < .05 for all but one PRO. CONCLUSION Treatment with SOF/VEL/VOX for 12 weeks led to significant and sustainable improvement in patient-reported outcomes in patients who had previously failed another direct-acting antiviral regimen.
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Affiliation(s)
- Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Maria Stepanova
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | | | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Meintz, Germany
| | - Marc Bourliere
- Department of Hepato-Gastroenterology, Hospital Saint Joseph, Marseille, France
| | - Stuart C Gordon
- Department of Gastroenterology, Henry Ford Hospital, Detroit, MI, USA
| | - Eugene Schiff
- Schiff Center For Liver Diseases, University of Miami, Miami, FL, USA
| | - Tram Tran
- Liver Disease and Transplant Center, Cedars-Sinai Medical Center, Los Angeles, LA, USA
| | - Issah Younossi
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | - Andrei Racila
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
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17
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Bourlière M, Pietri O, Castellani P, Oules V, Adhoute X. Sofosbuvir, velpatasvir and voxilaprevir: a new triple combination for hepatitis C virus treatment. One pill fits all? Is it the end of the road? Therap Adv Gastroenterol 2018; 11:1756284818812358. [PMID: 30574189 PMCID: PMC6295690 DOI: 10.1177/1756284818812358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/02/2018] [Indexed: 02/04/2023] Open
Abstract
The advent of oral direct-acting antiviral agents (DAAs) has dramatically improved the hepatitis C virus (HCV) treatment landscape in the last 4 years, providing cure rates over 95% with a shorter duration of treatment and a very good safety profile. This has enabled access to treatment in nearly all HCV infected patients. The launch of two pangenotypic fixed dose combinations (FDCs) in 2017 made a new step forward in HCV treatment by slightly increasing efficacy and more importantly allowing the treatment of patients without HCV genotyping, and in some cases without fibrosis assessment. However, retreatment of the few DAA failure patients was still an issue for some HCV genotypes. The launch of the triple regimen FDC, sofosbuvir/velpatasvir/voxilaprevir, solves this issue by providing a cure rate over 96% regardless of HCV genotype. In this review, we describe the current HCV treatment landscape and focus on the development of this triple FDC either in treatment-naïve or treatment-experienced patients with previous failure on a DAA regimen.
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Affiliation(s)
- Marc Bourlière
- Hepato-Gastroenterology Department, Hospital Saint Joseph, 26 Bd de Louvain 13008 Marseilles, France
| | - Olivia Pietri
- Hepato-Gastroenterology Department, Hospital Saint Joseph, Marseilles, France
| | - Paul Castellani
- Hepato-Gastroenterology Department, Hospital Saint Joseph, Marseilles, France
| | - Valérie Oules
- Hepato-Gastroenterology Department, Hospital Saint Joseph, Marseilles, France
| | - Xavier Adhoute
- Hepato-Gastroenterology Department, Hospital Saint Joseph, Marseilles, France
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18
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Younossi Z, Papatheodoridis G, Cacoub P, Negro F, Wedemeyer H, Henry L, Hatzakis A. The comprehensive outcomes of hepatitis C virus infection: A multi-faceted chronic disease. J Viral Hepat 2018; 25 Suppl 3:6-14. [PMID: 30398294 DOI: 10.1111/jvh.13005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 02/06/2023]
Abstract
Treatment of hepatitis C virus (HCV) infection has been revolutionized with the introduction of pangenotypic, interferon- and ribavirin-free regimens associated with high cure rates and a low side effect profile. Additionally, there is evidence that HCV cure reduces HCV complications, improves patient-reported outcomes and is cost-saving in most western countries in the long term. This is a review of the comprehensive burden of HCV and the value of eliminating HCV infection. With the introduction of the interferon-free all-oral, once a day pill treatment regimen for the cure of HCV, the potential to eliminate HCV by 2030 has become a possibility for some regions of the world. Nevertheless, there are barriers to screening, linkage to care, and treatment in many countries that must be overcome in order to reach this goal. In conclusion, globally, work must continue to ensure national policies are in place to support screening, linkage to care and affordable treatment in order to eliminate HCV.
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Affiliation(s)
- Zobair Younossi
- Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia.,Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia
| | - Georgios Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens Laiko, Athens, Greece
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, AP HP Hôpital La Pitié-Salpêtrière, Paris, France.,CNRS UMR 7087, INSERM UMR S-959, DHU I2B, Sorbonne Université, Paris, France
| | | | | | - Linda Henry
- Center for Outcomes Research in Liver Disease, Washington D.C
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece.,Hepatitis B and C Public Policy Association, L-2453 , Luxembourg
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19
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Yeoh SW, Holmes ACN, Saling MM, Everall IP, Nicoll AJ. Depression, fatigue and neurocognitive deficits in chronic hepatitis C. Hepatol Int 2018; 12:294-304. [PMID: 29931590 DOI: 10.1007/s12072-018-9879-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
Abstract
Patients with chronic hepatitis C virus (HCV) infection experience a range of symptoms including depression, fatigue and neurocognitive deficits, impairing quality of life. Depression, in particular, may be reactive to increased psychosocial stress, and the physical symptoms of advanced HCV or associated comorbidities. However, even patients at an early stage of HCV infection, with minimal hepatic inflammation or comorbidities, report more depressive symptoms and fatigue than the general population. Similarly, specific neurocognitive deficits occur in early stage HCV infection and are independent of the presence of depression or encephalopathy. Therefore, intracerebral neurobiological changes associated with HCV may potentially explain these symptoms. These changes may arise from infiltration of the brain by peripherally induced cytokines, as well as direct neuropathic effects of HCV viral particles penetrating the blood-brain barrier. These phenomena parallel those reported in human immunodeficiency virus (HIV) infection. HCV-associated intracerebral changes include upregulated inflammatory responses, altered neurotransmitter levels, hormonal dysregulation, and release of neurotoxic substances. These may subsequently lead to abnormal neuronal conduction and function in areas of the brain governing affective responses, emotional processing, motivation, attention and concentration. Although direct-acting antiviral medications lead to high rates of HCV clearance, intracerebral changes may not be subsequently reversed and symptoms of depression, fatigue and neurocognitive deficits may persist. There is an ongoing role for multidisciplinary care and pharmacotherapy to manage these symptoms in HCV patients. Furthermore, there may be opportunities for future therapies to specifically target and ameliorate HCV-associated intracerebral changes.
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Affiliation(s)
- Sern Wei Yeoh
- Department of Gastroenterology, Eastern Health, 3 West, Building B, 8 Arnold St, Box Hill, VIC, 3128, Australia.
| | - Alex C N Holmes
- Department of Psychiatry, University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Michael M Saling
- Melbourne School of Psychological Sciences, 12th Floor, Redmond Barry Building, Parkville Campus, University of Melbourne, Parkville, VIC, Australia, 3010.,Department of Clinical Neuropsychology, Austin Health, Heidelberg Repatriation Hospital, 300 Waterdale Rd, Ivanhoe, VIC, 3079, Australia.,Florey Institute for Neuroscience and Mental Health, 30 Royal Parade, Parkville, VIC, 3052, Australia
| | - Ian P Everall
- Department of Psychiatry, University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.,Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, UK
| | - Amanda J Nicoll
- Department of Gastroenterology, Eastern Health, 3 West, Building B, 8 Arnold St, Box Hill, VIC, 3128, Australia.,Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
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20
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Affiliation(s)
- Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.
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