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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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Rogal SS, Arnold RM, Chapko M, Hanusa BV, Youk A, Switzer GE, Sevick MA, Bayliss NK, Zook CL, Chidi A, Obrosky DS, Zickmund SL. The Patient-Provider Relationship Is Associated with Hepatitis C Treatment Eligibility: A Prospective Mixed-Methods Cohort Study. PLoS One 2016; 11:e0148596. [PMID: 26900932 PMCID: PMC4763474 DOI: 10.1371/journal.pone.0148596] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/17/2015] [Indexed: 12/11/2022] Open
Abstract
Hepatitis C virus (HCV) treatment has the potential to cure the leading cause of cirrhosis and hepatocellular carcinoma. However, only those deemed eligible for treatment have the possibility of this cure. Therefore, understanding the determinants of HCV treatment eligibility is critical. Given that effective communication with and trust in healthcare providers significantly influences treatment eligibility decisions in other diseases, we aimed to understand patient-provider interactions in the HCV treatment eligibility process. This prospective cohort study was conducted in the VA Pittsburgh Healthcare System. Patients were recruited after referral for gastroenterology consultation for HCV treatment with interferon and ribavirin. Consented patients completed semi-structured interviews and validated measures of depression, substance and alcohol use, and HCV knowledge. Two coders analyzed the semi-structured interviews. Factors associated with patient eligibility for interferon-based therapy were assessed using multivariate logistic regression. Of 339 subjects included in this analysis, only 56 (16.5%) were deemed eligible for HCV therapy by gastroenterology (GI) providers. In the multivariate logistic regression, patients who were older (OR = 0.96, 95%CI = 0.92-0.99, p = .049), reported concerns about the GI provider (OR = 0.40, 95%CI = 0.10-0.87, p = 0.02) and had depression symptoms (OR = 0.32, 95%CI = 0.17-0.63, p = 0.001) were less likely to be eligible. Patients described barriers that included feeling stigmatized and poor provider interpersonal or communication skills. In conclusion, we found that patients' perceptions of the relationship with their GI providers were associated with treatment eligibility. Establishing trust and effective communication channels between patients and providers may lower barriers to potential HCV cure.
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Affiliation(s)
- Shari S. Rogal
- Center for Health Equity Research and Promotion, Veteran’s Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Robert M. Arnold
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michael Chapko
- Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veteran’s Administration Healthcare Service, Seattle, Washington, United States of America
| | - Barbara V. Hanusa
- Center for Health Equity Research and Promotion, Veteran’s Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America
| | - Ada Youk
- Center for Health Equity Research and Promotion, Veteran’s Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Galen E. Switzer
- Center for Health Equity Research and Promotion, Veteran’s Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mary Ann Sevick
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
| | - Nichole K. Bayliss
- Center for Health Equity Research and Promotion, Veteran’s Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America
| | - Carolyn L. Zook
- School of Medicine, Oregon Health Sciences University, Portland, Oregon, United States of America
| | - Alexis Chidi
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - David S. Obrosky
- Center for Health Equity Research and Promotion, Veteran’s Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Susan L. Zickmund
- Center for Health Equity Research and Promotion, Veteran’s Administration, Pittsburgh Healthcare Service, Pittsburgh, Pennsylvania, United States of America
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Abstract
Although HCV infection mainly induces liver injury, chronic disease is systemic. Moreover, host and viral factors, as well as comorbidities, may influence the chance of achieving a sustained virological response or disease outcome. Although there are sufficient data on the use of peg-interferon and ribavirin in patients with comorbidities, there is very little data on first generation protease inhibitors, which include significant drug-drug interactions and have therefore been administered with caution in these patients. The availability of new, more effective direct acting antivirals should significantly change this scenario. All these issues are discussed in this review.
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Affiliation(s)
- Vincenzo Boccaccio
- Department of Internal Medicine, A.O. Fatebenefratelli e Oftalmico, Milan, Italy
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