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Bollerup S, Hallager S, Baek O, Krarup H, Madsen LG, Thielsen P, Balslev U, Mens H, Barfod T, Rye Clausen M, Hobolth L, Gerstoft J, Weis N. Implementation of treatment recommendations for chronic hepatitis B in patients attending specialized hospital care in Denmark - a region wide study. Scand J Gastroenterol 2020; 55:843-847. [PMID: 32568561 DOI: 10.1080/00365521.2020.1779803] [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] [Indexed: 02/08/2023]
Abstract
Objective: To evaluate implementation of national guideline recommendations on treatment initiation for chronic hepatitis B (CHB) in Denmark.Methods: Using DANHEP, a nationwide cohort of chronic hepatitis B and C patients attending specialized hospital care in Denmark, we performed a descriptive cohort study from January 2002 through December 2017. We identified patients with CHB in 3 of 5 Danish regions, with at least two hospital/outpatient clinic visits during the study period.Results: We identified 990 CHB patients who remained untreated throughout the study period, and 265 who initiated treatment. At their last visit 952/990 (96%, 95% CI 95-97) untreated patients did not meet current national criteria for treatment initiation while 198/265 (75%, 95% CI 69-80) who initiated treatment met the national criteria. Overall, 198/236 (84%, 95% CI 79-88) who met national treatment criteria, initiated treatment.Conclusion: The majority of CHB patients received care in line with national guideline recommendations for treatment initiation. We found that only few patients eligible for treatment remained untreated. However, a fourth of patients who received treatment were not eligible according to national guidelines.
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Affiliation(s)
- Signe Bollerup
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Sofie Hallager
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ole Baek
- Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henrik Krarup
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark.,Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Lone Galmstrup Madsen
- Department of Medical Gastroenterology, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Thielsen
- Department of Gastroenterology, Herlev Hospital, Herlev, Denmark
| | - Ulla Balslev
- Department of Infectious Diseases, Herlev Hospital, Herlev, Denmark
| | - Helene Mens
- Department of Lung- and Infectious Diseases, North Zealand Hospital, Hilleroed, Denmark
| | - Toke Barfod
- Department of Internal Medicine and Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Mette Rye Clausen
- Department of Medical Gastroenterology and Hepatology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Lise Hobolth
- Department of Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
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Lee HM, Ahn J, Kim WR, Lim JK, Nguyen M, Pan CQ, Kim D, Mannalithara A, Te H, Trinh H, Chu D, Tran T, Woog J, Lok AS. A Comparison Between Community and Academic Practices in the USA in the Management of Chronic Hepatitis B Patients Receiving Entecavir: Results of the ENUMERATE Study. Dig Dis Sci 2019; 64:358-366. [PMID: 30238203 DOI: 10.1007/s10620-018-5281-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The management of chronic hepatitis B patients is not well characterized in real-world practice. We compared baseline characteristics of CHB patients on entecavir, the frequency of on-treatment monitoring, and the effectiveness of ETV treatment between academic and community practices. METHODS Treatment-naïve CHB patients ≥18 years old, treated with ETV for ≥12 months from 2005 to 2013, in 26 community and academic practices throughout the USA were retrospectively evaluated. RESULTS Of 841 patients enrolled, 658 (65% male, 83% Asian, median age 47, 9% with cirrhosis) met inclusion criteria. Half of the patients (52%) were from community practices. A lower percentage of patients in community practices had cirrhosis or liver cancer (5 vs. 14%). Community practices more often treated patients with baseline ALT < 2 × ULN. Over a median follow-up of 4 years, community practices were more likely to discontinue ETV with less frequent laboratory monitoring compared to academic practices. The 5-year cumulative probability of ALT normalization was greater among patients treated in community practices (70 vs. 50%, p < 0.001), but the 5-year cumulative probability of undetectable HBV DNA was lower (45 vs. 70%, p < 0.001) than those treated in academic practices. CONCLUSION Academic practices saw CHB patients with more advanced liver disease, more often followed AASLD guidelines, and monitored patients on ETV treatment more frequently than community practices. While patients in community practices were less likely to achieve undetectable HBV DNA and more likely to achieve ALT normalization, the rates of HBeAg loss and seroconversion as well as HBsAg loss were similar.
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Affiliation(s)
- Hannah M Lee
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Medical Center, 1200 E. Broad St., 14th Floor, P.O. Box 980341, Richmond, VA, 23298, USA.
| | - Joseph Ahn
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR, USA
| | - W Ray Kim
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
| | | | - Mindie Nguyen
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
| | - Calvin Q Pan
- Division of Gastroenterology and Hepatology, NYU Langone Health, NYU School of Medicine, New York, USA
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
| | - Ajitha Mannalithara
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
| | - Helen Te
- Digestive Disease Center, University of Chicago, Chicago, IL, USA
| | - Huy Trinh
- San Jose Gastroenterology, San Jose, CA, USA
| | - Danny Chu
- Albert Einstein College of Medicine, New York, NY, USA
| | - Tram Tran
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - Anna S Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
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Subic M, Zoulim F. How to improve access to therapy in hepatitis B patients. Liver Int 2018; 38 Suppl 1:115-121. [PMID: 29427482 DOI: 10.1111/liv.13640] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 02/06/2023]
Abstract
Despite the availability of a preventive vaccine and active antiviral treatments that stop disease progression and reduce the risk of hepatocellular carcinoma, hepatitis B is still a major public health problem. Only an estimated 10% of the 257 million people living with HBV have been diagnosed and as few as 1% are being adequately treated. Barriers to diagnosis and treatment include: (i) limited awareness and lack of knowledge about HBV infection and HBV-related diseases; (ii) under-diagnosis with insufficient screening and referral to care; (iii) limited treatment due to drug availability, costs, reimbursement policies and the need for long-term or life-long therapy. These barriers and the actions needed to improve access to treatment are strongly influenced by the prevalence of infection and affect middle-high vs low-middle income countries differently, where most HBV carriers are found. In high-prevalence regions and low-to middle-income countries, the main challenges are availability and cost while in low-prevalence regions and middle-to high-income countries low screening rates, public awareness, social stigma and discrimination play an important role. Overcoming these challenges on a global scale is a complex clinical and public health challenge and multilateral commitment from pharmaceutical companies, governments, funders and the research community is lacking. The new WHO 2016 Global Health Sector Strategy on viral hepatitis targets testing and treatment, suggesting that important but strong actions are needed from advocacy groups, scientific societies and funding agencies to foster awareness and access to cure.
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Affiliation(s)
- Miroslava Subic
- Department of Hepatology, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fabien Zoulim
- Department of Hepatology, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,INSERM U1052-Cancer Research Center of Lyon (CRCL), Lyon, France.,UMR_S1052, CRCL, University of Lyon, Lyon, France
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Chang MS, Nguyen MH. Epidemiology of hepatitis B and the role of vaccination. Best Pract Res Clin Gastroenterol 2017; 31:239-247. [PMID: 28774405 DOI: 10.1016/j.bpg.2017.05.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/16/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023]
Abstract
Hepatitis B virus (HBV) is a major cause of morbidity and mortality with a disproportionate impact on Asia and Africa. Current guidelines recommend screening at-risk populations for chronic HBV infection so that diagnosed individuals can be linked to appropriate hepatitis care. The vast majority of infected individuals are undiagnosed and untreated, and are at risk of developing cirrhosis, liver failure, and hepatocellular carcinoma. In individuals who are not yet infected, the HBV vaccine is safe and highly effective at preventing disease transmission. Countries with successful vaccination programs have been able to dramatically reduce their HBV prevalence. A concerted effort to screen, treat, and vaccinate at-risk individuals has the potential to eliminate HBV as a public health threat by 2030.
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Affiliation(s)
- Matthew S Chang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA 94304, USA.
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, CA 94304, USA.
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