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Huang R, Shang J, Chen H, Li J, Xie Q, Feng J, Wei L, Rao H. Sustained virologic response improved the long-term health-related quality of life in patients with chronic hepatitis C: a prospective national study in China. BMC Infect Dis 2024; 24:72. [PMID: 38200419 PMCID: PMC10782531 DOI: 10.1186/s12879-023-08940-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND To investigate the trends in health-related quality of life (HRQoL) among hepatitis C virus (HCV) patients and to assess the longitudinal impact of antiviral therapy on their well-being. METHODS In this prospective multicenter observational study in adults with HCV infection, sociodemographic, clinical characteristics and EQ-5D questionnaires were collected. Generalized estimating equation (GEE) models were used to assess the associations between these variables and changes in HRQoL over time. RESULTS 456 patients were included, with a median age of 46.5 (36.5-57.0) years, of which 262 (57.5%) were males and 44 (9.6%) had cirrhosis. 335 patients (73.5%) receiving antiviral therapy and 61.8% achieved sustained virologic response (SVR). The baseline EQ-5D utility and EQ-VAS were 0.916 ± 0.208 and 80.6 ± 13.0. In multivariable analysis of GEE estimation, achieving SVR24 was positively associated with EQ-5D utility (p = 0.000) and EQ-VAS (p = 0.000) over time. Age and income were shown to be significant predictors of EQ-5D utility, while gender, age and genotype were associated with EQ-VAS over time. CONCLUSIONS SVR improved long-term HRQoL in HCV patients in the first few years following viral clearance. Certain sociodemographic factors, such as gender, age, income as well as genotype, significantly influenced long-term changes in patients' quality of life. TRIAL REGISTRATION NCT01594554. Registration date: 09/05/2012.
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Affiliation(s)
- Rui Huang
- Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University People's Hospital, Peking University Hepatology Institute, Beijing International Cooperation Base for Science and Technology On NAFLD Diagnosis, No.11 Xizhimen South Street, Beijing, 100044, China
| | - Jia Shang
- Henan Provincial People's Hospital, No.7 Weiwu Street, Zhengzhou, 463599, China
| | - Hong Chen
- First Hospital of Lanzhou University, No.1 Donggang west Street, Lanzhou, 730013, China
| | - Jun Li
- First Affiliated Hospital with Nanjing Medical University, No.22 Hankou Street, Nanjing, 210033, China
| | - Qing Xie
- Medical College, Ruijin Hospital, Shanghai Jiaotong University, No. 573, Xujiahui Street, Shanghai, 200020, China
| | - Jiajun Feng
- Department of Marketing, School of Business, Renmin University of China, No. 59 Zhongguancun Avenue, Beijing, 100871, China
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, No.168, Litang Road, Changping District, Beijing, 102218, China
| | - Huiying Rao
- Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University People's Hospital, Peking University Hepatology Institute, Beijing International Cooperation Base for Science and Technology On NAFLD Diagnosis, No.11 Xizhimen South Street, Beijing, 100044, China.
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2
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Cheng Q, Cunningham EB, Shih S, Amin J, Bruneau J, Artenie AA, Powis J, Litwin AH, Cooper C, Dalgard O, Hellard M, Bruggmann P, Marks P, Lacombe K, Stedman C, Read P, Hajarizadeh B, Dunlop AJ, Conway B, Feld JJ, Dore GJ, Grebely J. Patient-Reported Outcomes During and After Hepatitis C Virus Direct-Acting Antiviral Treatment Among People Who Inject Drugs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:883-892. [PMID: 36646278 DOI: 10.1016/j.jval.2022.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVES People who inject drugs (PWID) are at a high risk of hepatitis C virus (HCV) infection. HCV cure is associated with improved patient-reported outcomes (PROs), but there are little data among PWID. This study aimed to assess the change in PROs during and after HCV direct-acting antiviral (DAA) treatment. METHODS This analysis used data from 2 clinical trials of DAA treatment in PWID. PROs assessed included health-related quality of life, social functioning, psychological distress, housing, and employment. Generalized estimating equations and group-based trajectory modeling were used to assess changes in PROs over time. RESULTS No significant changes in the 3-level version of EQ-5D scores, EQ visual analogue scale scores, social functioning, psychological distress, and housing were observed over the 108-week study period. There was a significant increase in the proportion of participants employed (18% [95% confidence interval (CI) 12%-23%] at baseline to 28% [95% CI 19%-36%] at the end of the study). Participants were more likely to be employed at 24 weeks and 108 weeks after commencing treatment. Having stable housing increased the odds of being employed (odds ratio 1.70; 95% CI 1.00-2.90). The group-based trajectory modeling demonstrated that most outcomes remained stable during and after DAA treatment. CONCLUSIONS Although no significant improvement was identified in health-related quality of life after HCV DAA treatment, there was a modest but significant increase in employment during study follow-up. The study findings support the need for multifaceted models of HCV care for PWID addressing a range of issues beyond HCV treatment to improve quality of life.
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Affiliation(s)
- Qinglu Cheng
- The Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia.
| | - Evan B Cunningham
- The Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Sophy Shih
- The Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Janaki Amin
- The Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia; Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Julie Bruneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Département de médecine, Université de Montréal, Montréal, QC, Canada
| | - Adelina A Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Jeff Powis
- Infection Prevention and Control, Michael Garron Hospital, Toronto, ON, Canada
| | - Alain H Litwin
- Prisma Health Addiction Medicine Centre, Greenville, SC, USA; School of Medicine - Greenville, University of South Carolina, Greenville, SC, USA; School of Health Research, Clemson University, Clemson, SC, USA
| | - Curtis Cooper
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Margaret Hellard
- The Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Disease, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Philippa Marks
- The Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Karine Lacombe
- Faculté de médecine, Sorbonne Université, Paris, France; Infectious Diseases Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Catherine Stedman
- Department of Medicine, University of Otago, Christchurch, New Zealand; Gastroenterology Department, Christchurch Hospital, Christchurch, New Zealand
| | | | - Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Adrian J Dunlop
- Drug & Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Toronto, ON, Canada
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia; St Vincent's Hospital, Sydney, NSW, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
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3
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Lynch EN, Russo FP. Outcomes and Follow-Up after Hepatitis C Eradication with Direct-Acting Antivirals. J Clin Med 2023; 12:jcm12062195. [PMID: 36983196 PMCID: PMC10056757 DOI: 10.3390/jcm12062195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/27/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
Treatment of hepatitis C (HCV) has been revolutionized with the introduction of direct-acting antivirals (DAAs). Patients can be treated at more advanced stages of liver disease, with a growing number of cirrhotic patients achieving sustained virological response (SVR). Long-term outcomes for cured patients and the optimal follow-up care of patients after SVR are yet to be defined, because most studies on cirrhotic patients cured with DAAs have a short follow-up period. There are many open questions related to patient management after viral eradication with DAAs, such as which could be the most reliable non-invasive tool to predict liver-related complications, or to what extent viral eradication reduces the risk of liver disease progression in the long term. Growing evidence supports the personalization of follow-up care based on individual risk. The aim of this narrative review is to analyze the impact of viral eradication with DAAs on clinically significant portal hypertension, hepatocellular carcinoma, and extrahepatic manifestations, as well as to summarize indications for optimal follow-up care of HCV patients treated with DAAs.
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Affiliation(s)
- Erica Nicola Lynch
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padova, Italy
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padova, Italy
- Correspondence:
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4
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Marcellin F, Mourad A, Lemoine M, Kouanfack C, Seydi M, Carrieri P, Attia A, Protopopescu C, Lacombe K, Boyer S. Patient-reported outcomes with direct-acting antiviral treatment for hepatitis C in West and Central Africa (TAC ANRS 12311 trial). JHEP Rep 2022; 5:100665. [PMID: 36686592 PMCID: PMC9853347 DOI: 10.1016/j.jhepr.2022.100665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/24/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
Background & Aims Patient-reported outcomes (PROs) are poorly documented for patients with chronic hepatitis C on direct-acting antiviral (DAA) treatment in low-to-middle-income countries. We documented PROs during and after DAA treatment in participants of the TAC ANRS 12311 trial (West and Central Africa). Methods Trial participants received a 12-week regimen containing either sofosbuvir plus ribavirin (HCV genotype 2, n = 40), or sofosbuvir plus ledipasvir (HCV genotypes 1 and 4, n = 80). Health-related quality of life (SF-12), fatigue (Piper Fatigue scale), and self-reported symptoms (35-symptom list) were assessed at enrolment (Week (W) 0), during treatment (W2, W4, W8 and W12) and after treatment (W24 and W36). These PROs were compared between W0 and W36 (Wilcoxon signed-rank or McNemar tests). Mixed-effects linear regression models helped identify correlates of physical and mental quality of life component summaries (PCS and MCS) in a longitudinal analysis. Results Most PROs were significantly improved 24 weeks after treatment end (W36), without significant differences between treatment groups. For the post-treatment period, multivariable analysis showed significant increases in PCS for patients with cirrhosis and in MCS for patients in the sofosbuvir plus ribavirin group. A higher number of self-reported symptoms at W0 was associated with lower PCS and MCS, older age and cirrhosis with lower PCS, and male sex and HCV cure with higher PCS. Conclusions Sofosbuvir-based DAA therapy was associated with a significant improvement in PROs 6 months after treatment end in patients with chronic HCV infection from Central and West Africa. These findings may guide HCV treatment providers in low-to-middle-income countries to deliver pre-treatment information concerning the benefits of DAAs beyond viral eradication. ClinicalTrialsgov Identifier NCT02405013. Impact and implications Perceptions and experiences (i.e. "patient-reported outcomes") of patients with chronic hepatitis C receiving direct-acting antivirals (DAAs) are poorly documented in the African setting. This study shows significant improvements in health-related quality of life, fatigue, and self-reported symptoms 24 weeks after the end of a 12-week sofosbuvir-based DAA regimen in 120 patients from Central and West Africa. These findings substantially add to the body of knowledge about DAA therapy in the African setting. Treatment providers should be encouraged to inform patients of the benefits of DAAs beyond viral eradication, to increase treatment adherence and retention in care.
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Key Words
- DAA, direct-acting antiviral
- EOT, end-of-treatment
- HRQL, health-related quality of life
- LMICs, low-to-middle income countries
- MCS, mental component summary
- MOS SF-12, Medical Outcomes Study 12-item short-form general health survey
- MOS, Medical Outcomes Study
- PCS, physical component summary
- PROs, patient-reported outcomes
- SOF/LDV, sofosbuvir plus ledipasvir
- SOF/RBV, sofosbuvir plus ribavirin
- SVR, sustained virological response
- W, week
- WHO, World Health Organization
- West Africa
- direct-acting antivirals
- health-related quality of life
- hepatitis C
- symptoms
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Affiliation(s)
- Fabienne Marcellin
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Abbas Mourad
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Maud Lemoine
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Section of Hepatology and Gastroenterology, St Mary’s Hospital, Imperial College, London, UK
| | - Charles Kouanfack
- Hôpital de Jour, Hôpital Central de Yaoundé, Cameroon,Faculté de Médecine et des Sciences Pharmaceutiques, Université de Dschang, Dschang, Cameroon
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, CHU Fann, Dakar, Senegal
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
| | - Alain Attia
- Service d’hépatologie, CHU Yopougon, Abidjan, Cote d’Ivoire
| | - Camelia Protopopescu
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France,Corresponding author. Address: UMR 1252 SESSTIM, Aix-Marseille Univ, Faculté de Médecine 3e étage - Aile Bleue 27, boulevard Jean Moulin, 13385 Marseille cedex 5 – France. Tel.: +33 4 13 73 22 90..
| | - Karine Lacombe
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP, Paris, France,APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - Sylvie Boyer
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Marseille, France
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5
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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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Evon DM, Dong M, Reeve BB, Peter J, Michael L, Lok AS, Nelson DR, Stewart PW. Sustainable and equivalent improvements in symptoms and functional well-being following viral cure from ledipasvir/sofosbuvir versus elbasvir/grazoprevir for chronic hepatitis C infection: Findings from the randomized PRIORITIZE trial. J Viral Hepat 2022; 29:795-806. [PMID: 35657133 DOI: 10.1111/jvh.13716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/25/2022] [Indexed: 12/09/2022]
Abstract
The PRIORITIZE trial (clinicaltrials.gov: NCT02786537) was the first comparative effectiveness study to directly compare ledipasvir/sofosbuvir (LDV/SOF) and elbasvir/grazoprevir (EBR/GZR) for the treatment of chronic hepatitis C virus (HCV). A secondary aim of this study was to compare LDV/SOF and EBR/GZR on sustainable changes in several HCV-associated symptoms and functional well-being in patients who achieved sustained virological response (SVR). PRIORITIZE, a randomized controlled trial conducted between 2016 and 2020, evaluated change in six PROMIS® symptom scores (fatigue, sleep disturbance, cognitive disturbance, nausea, diarrhoea, abdominal pain) and functional well-being using the disease-specific HCV-PRO instrument. Survey assessments were administered at baseline, early post-treatment (median = 6 months) and late post-treatment (median = 21 months). Constrained longitudinal linear mixed-effects models were used to evaluate within-treatment change and between-treatment differences. Data from 793 participants (average 55 years old, 57% male, 44% black, 17% with cirrhosis) were analysed. From baseline to early post-treatment, 5 out of 6 symptoms and functional well-being significantly improved (all p's < .05). In the LDV/SOF arm, mean changes ranged from -3.73 for nausea to -6.41 for fatigue and in the EBR/GZR, mean changes ranged from -2.19 for cognitive impairment to -4.67 for fatigue. Change of >3 points was consider clinically meaningful. Improvements in most symptoms slightly favoured LDV/SOF, although the magnitude of differences between the regimens were small. Both regimens demonstrated significant improvements in symptoms and functional well-being that were sustained during the late post-treatment phase. EBR/GZR and LDV/SOF regimens had clinically equivalent and durable improvements in HCV symptoms and functional well-being up to two years after SVR.
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Affiliation(s)
- Donna M Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Meichen Dong
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joy Peter
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Larry Michael
- Center for Gastroenterology Biology and Disease, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - David R Nelson
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Paul W Stewart
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
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7
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Benade M, Rosen S, Antoniak S, Chasela C, Stopolianska Y, Barnard T, Gandhi MM, Ivanchuk I, Tretiakov V, Dible J, Minior T, Chew KW, van der Horst C, Tsenilova Z, Sanne I. Impact of direct-acting antiviral treatment of hepatitis C on the quality of life of adults in Ukraine. BMC Infect Dis 2022; 22:650. [PMID: 35896987 PMCID: PMC9330669 DOI: 10.1186/s12879-022-07615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/04/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Direct-acting antivirals (DAAs) are highly effective in achieving sustained virologic response among those with chronic hepatitis C virus (HCV) infection. Quality of life (QOL) benefits for an HCV-infected population with high numbers of people who inject drugs and people living with HIV (PLHIV) in Eastern Europe have not been explored. We estimated such benefits for Ukraine. METHODS Using data from a demonstration study of 12-week DAA conducted in Kyiv, we compared self-reported QOL as captured with the MOS-SF20 at study entry and 12 weeks after treatment completion (week 24). We calculated domain scores for health perception, physical, role and social functioning, mental health and pain to at entry and week 24, stratified by HIV status. RESULTS Among the 857 patients included in the final analysis, health perception was the domain that showed the largest change, with an improvement of 85.7% between entry and week 24. The improvement was larger among those who were HIV negative (104.4%) than among those living with HIV (69.9%). Other domains that showed significant and meaningful improvements were physical functioning, which improved from 80.5 (95% CI 78.9-82.1) at study entry to 89.4 (88.1-90.7) at 24 weeks, role functioning (64.5 [62.3-66.8] to 86.5 [84.9-88.2]), social functioning (74.2 [72.1-76.2] to 84.8 [83.2-86.5]) and bodily pain (70.1 [68.2-72.0] to 89.8 [88.5-91.1]). Across all domains, QOL improvements among PLHIV were more modest than among HIV-negative participants. CONCLUSION QOL improved substantially across all domains between study entry and week 24. Changes over the study period were smaller among PLHIV.
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Affiliation(s)
- M Benade
- Boston University School of Public Health, Boston, MA, USA.
| | - S Rosen
- Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - C Chasela
- Right to Care, Centurion, Pretoria, South Africa
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - T Barnard
- United States Agency for International Development, Washington, DC, USA
| | - M M Gandhi
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Ivanchuk
- Public Health Centre of Ministry of Healthcare of Ukraine, Kyiv, Ukraine
| | | | - J Dible
- United States Agency for International Development, Washington, DC, USA
| | - T Minior
- United States Agency for International Development, Washington, DC, USA
| | - K W Chew
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | | | - I Sanne
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Right to Care, Centurion, Pretoria, South Africa
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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8
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Byrne CJ, Radley A, Inglis SK, Beer L, Palmer N, Duc Pham M, Allardice K, Wang H, Robinson E, Hermansson M, Semizarov D, Healy B, Doyle JS, Dillon JF. Reaching people receiving opioid agonist therapy at community pharmacies with hepatitis C virus: an international randomised controlled trial. Aliment Pharmacol Ther 2022; 55:1512-1523. [PMID: 35538396 DOI: 10.1111/apt.16953] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 04/19/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Conventional healthcare models struggle to engage those at risk of hepatitis C virus (HCV) infection. This international study evaluated point-of-care (PoC) HCV RNA diagnostic outreach and direct-acting antiviral (DAA) treatment for individuals receiving opioid agonist therapy (OAT) in community pharmacies. AIMS We assessed the effectiveness of a roving nurse-led pathway offering PoC HCV RNA testing to OAT clients in community pharmacies relative to conventional care. METHODS Pharmacies in Scotland, Wales, and Australia were randomised to provide PoC HCV RNA testing or conventional referral. Pharmacists directed OAT clients to on-site nurses (intervention) or local clinics (control). Infected participants were treated with DAAs, alongside OAT. Primary outcome was the number of participants with sustained virologic response at 12 weeks (SVR) and analysed using mixed effects logistic regression in the intention-to-treat (ITT) population. RESULTS Forty pharmacies were randomised. The ITT population contained 1410 OAT clients. In the conventional arm (n = 648), 62 (10%) agreed to testing, 17 (27%) were tested, 6 (35%) were positive and 5 (83%) initiated treatment. In the intervention arm (n = 762), 148 (19%) agreed to testing, 144 (97%) were tested, 23 (16%) were positive and 22 (96%) initiated treatment. SVR was obtained by 2 (40%; conventional) and 18 (82%; intervention). Intervention arm participants had higher odds of testing, OR 16.95 (7.07-40.64, p < 0.001); treatment, OR 4.29 (1.43-12.92, p = 0.010); and SVR, OR 8.64 (1.82-40.91, p = 0.007). CONCLUSIONS Nurse-led PoC diagnosis in pharmacies made HCV care more accessible for OAT clients relative to conventional care. However, strategies to improve testing uptake are required. TRIAL REGISTRATION NCT03935906.
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Affiliation(s)
- Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.,Tayside Clinical Trials Unit, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Andrew Radley
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Lewis Beer
- Tayside Clinical Trials Unit, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Nicki Palmer
- Department of Microbiology and Infectious Diseases Cardiff, Public Health Wales, Cardiff, UK
| | - Minh Duc Pham
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Kate Allardice
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Huan Wang
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Emma Robinson
- Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | - Brendan Healy
- Department of Microbiology and Infectious Diseases Cardiff, Public Health Wales, Cardiff, UK
| | - Joseph S Doyle
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia.,Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.,Department of Gastroenterology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK
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9
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Gormley MA, Akiyama MJ, Rennert L, Howard KA, Norton BL, Pericot-Valverde I, Muench S, Heo M, Litwin AH. Changes in health-related quality of life for HCV-infected people who inject drugs on opioid agonist treatment following sustained virologic response. Clin Infect Dis 2021; 74:1586-1593. [PMID: 34331539 DOI: 10.1093/cid/ciab669] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although efforts to treat hepatitis C virus (HCV) in people who inject drugs (PWID) yield high rates of sustained virologic response (SVR), the relationship between successful HCV treatment and health-related quality of life (HRQOL) among PWID is poorly understood. This study examined HRQOL changes throughout HCV treatment and post-treatment for PWID achieving SVR. METHODS Participants included 141 PWID who achieved SVR following HCV treatment onsite at three opioid agonist treatment (OAT) clinics in Bronx, NY. The EQ-5D-3L assesses five health dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), producing an index of HRQOL ranging from 0-1. EQ-5D-3L was measured at baseline, 4-, 8-, and 12-weeks during treatment and 12- and 24-weeks post-treatment. Linear mixed effects regression models were used to assess changes in the mean EQ-5D-3L index over time. RESULTS Mean EQ-5D-3L index baseline was 0.66 (SE=0.02). Whereas over half the population reported no baseline problems with self-care (85.1%), usual activities (56.0%), and mobility (52.5%), at least two-thirds reported problems with pain/discomfort (78.0%) and anxiety/depression (66.0%), with 22.0% and 21.3% reporting extreme problems for pain/discomfort and anxiety/depression, respectively. Twenty-four weeks post-treatment, proportions reporting pain/discomfort and anxiety/depression decreased by 25.7% and 24.0%, respectively. The mean EQ-5D-3L index significantly improved during treatment (p<0.0001), and improvement was sustained following treatment completion, with mean EQ-5D-3L index of 0.77 (SE=0.02) 12-weeks post-SVR. CONCLUSIONS HCV treatment led to sustained improvement in HRQOL for PWID on OAT who achieved SVR. Future research is necessary to determine whether improvements in HRQOL can be sustained beyond 12-weeks post-SVR.
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Affiliation(s)
| | - Matthew J Akiyama
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Kerry A Howard
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Brianna L Norton
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sam Muench
- Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Moonseong Heo
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Alain H Litwin
- Clemson University School of Health Research, Clemson, SC, USA.,Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA.,Department of Internal Medicine, Prisma Health, Greenville, SC, USA
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