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Spaderna M, Kattakuzhy S, Kang SJ, George N, Bijole P, Ebah E, Eyasu R, Ogbumbadiugha O, Silk R, Gannon C, Davis A, Cover A, Gayle B, Narayanan S, Pao M, Kottilil S, Rosenthal E. Hepatitis C cure and medications for opioid use disorder improve health-related quality of life in patients with opioid use disorder actively engaged in substance use. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103906. [PMID: 36384062 PMCID: PMC9868066 DOI: 10.1016/j.drugpo.2022.103906] [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: 05/13/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aims to determine whether Hepatitis C (HCV) treatment improves health-related quality of life (HRQL) in patients with opioid use disorder (OUD) actively engaged in substance use, and which variables are associated with improving HRQL in patients with OUD during HCV treatment. METHODS Data are from a prospective, open-label, observational study of 198 patients with OUD or opioid misuse within 1 year of study enrollment who received HCV treatment with the primary endpoint of Sustained Virologic Response (SVR). HRQL was assessed using the Hepatitis C Virus Patient Reported Outcomes (HCV-PRO) survey, with higher scores denoting better HRQL. HCV-PRO surveys were conducted at Day 0, Week 12, and Week 24. A mixed-effects model investigated which variables were associated with changing HCV-PRO scores from Day 0 to Week 24. RESULTS Patients had a median age of 57 and were predominantly male (68.2%) and Black (83.3%). Most reported daily-or-more drug use (58.6%) and injection drug use (IDU) (75.8%). Mean HCV-PRO scores at Day 0 and Week 24 were 64.0 and 72.9, respectively. HCV-PRO scores at Week 24 improved compared with scores at Day 0 (8.7; p<0.001). Achieving SVR (10.4; p<0.001) and receiving medications for OUD (MOUD) at Week 24 (9.5; p<0.001) were associated with improving HCV-PRO scores. HCV-PRO scores increased at Week 24 for patients who experienced no decline in IDU frequency (8.1; p<0.001) or had a UDS positive for opioids (8.0; p<0.001) or cocaine (7.5; p=0.003) at Week 24. CONCLUSION Patients with OUD actively engaged in substance use experience improvement in HRQL from HCV cure unaffected by ongoing substance use. Interventions to promote HCV cure and MOUD engagement could improve HRQL for patients with OUD.
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Affiliation(s)
- Max Spaderna
- Department of Psychiatry, University of Maryland School of Medicine, 110 South Paca Street 4(th) Floor, Baltimore, Maryland 21201, United States.
| | - Sarah Kattakuzhy
- Department of Psychiatry, University of Maryland School of Medicine, 110 South Paca Street 4(th) Floor, Baltimore, Maryland 21201, United States; Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Sun Jung Kang
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Room 2E422A, Bethesda, Maryland 20892, United States
| | - Nivya George
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States
| | - Phyllis Bijole
- HIPS, 906 H Street NE, Washington, District of Columbia 20002, United States
| | - Emade Ebah
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Rahwa Eyasu
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Onyinyechi Ogbumbadiugha
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Rachel Silk
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Catherine Gannon
- DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States; Critical Care Medicine Department, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, Maryland 20892, United States
| | - Ashley Davis
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Amelia Cover
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Britt Gayle
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Shivakumar Narayanan
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States
| | - Maryland Pao
- Office of the Clinical Director, National Institute of Mental Health, National Institutes of Health, 6001 Executive Boulevard, Room 6200, Bethesda, Maryland 20892, United States
| | - Shayamasundaran Kottilil
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
| | - Elana Rosenthal
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, Maryland 21201, United States; DC Partnership for HIV/AIDS Progress, Clinical Research Program, Washington, District of Columbia, United States
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Estefan S, Brandão-Melo CE, Dos Santos Silva CM, Gomes DCK, Cardoso P, Costa MHS. Metabolic Evaluation in Patients With Hepatitis C Treated With Direct Antiviral Agents. Front Med (Lausanne) 2021; 8:631600. [PMID: 34136497 PMCID: PMC8200477 DOI: 10.3389/fmed.2021.631600] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
Epidemiological data clearly indicate a link between hepatitis C virus (HCV) and altered glucose homeostasis. Objective: To evaluate the response of treatment with direct antiviral agents (DAAs) on metabolic variables of patients with hepatitis C. Methods: Observational, cross-sectional study in a sample of patients with hepatitis C starting therapy with DAAs followed on the hepatology division of Federal University of Rio de Janeiro State. Data were collected in two stages: before the start of therapy and between 12 and 52 weeks after obtaining the sustained virological response. Results: In the baseline assessment of the 97 patients selected, 19.3% were obese, 38.6% were overweight, 50% were hypertensive, 43.8% were pre-diabetic, 12.5% were diabetic, 31.2% were dyslipidemic, and 21.8% had metabolic syndrome. There was an increase in total cholesterol and LDL levels (p < 0.001), and a non-significant reduction in blood glucose, glycated hemoglobin, insulin, and HOMA-IR levels after treatment. In the post-treatment, there was a reduction in fibrosis (p = 0.016), with a reduction in the levels of GGT, AST, and ALT (all with p < 0.001), as well as in the FIB4 and APRI scores (both with p < 0.001) and in the degree of fibrosis evaluated by elastography represented in kPa (p = 0.006). The blood glucose level was higher in patients with steatosis (p = 0.039) after treatment. There was a positive pre-treatment correlation between the degree of fibrosis (kPa) and FIB4 (r = 0.319, p = 0.004), APRI (r = 0.287, p = 0.010), and the NAFLD score (r = 0.275, p = 0.016). Conclusion: Patients with hepatitis C had a high prevalence of metabolic disturbance in the pre-treatment phase, but the therapy did not show beneficial effects, especially on glucose metabolism.
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Affiliation(s)
- Sergio Estefan
- Endocrinology and Hepatology Division of Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | | | | | - Danilo Cosme Klein Gomes
- Endocrinology and Hepatology Division of Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Paula Cardoso
- Endocrinology and Hepatology Division of Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Marcia Helena S Costa
- Endocrinology and Hepatology Division of Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
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Vivaldini SM, Ribeiro RA, Mosimann Júnior G, Tonini KC, Pereira GFM, Araújo WND. A real-life study of the positive response to DAA-based therapies for hepatitis C in Brazil. Braz J Infect Dis 2021; 25:101573. [PMID: 33836175 PMCID: PMC9392166 DOI: 10.1016/j.bjid.2021.101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/26/2021] [Accepted: 02/10/2021] [Indexed: 11/23/2022] Open
Abstract
A retrospective cohort of 11,308 chronic hepatitis C infected patients treated with regimens that included Sofosbuvir (SOF), Daclatasvir (DCV), Simeprevir (SMV), or an association of Ombitasvir, Veruprevir/Ritonavir and Dasabuvir (3D) with or without Ribavirin (RBV) were assessed for sustained virologic response (SVR) or viral cure after a 12-week treatment. Logistic regression analyses were used to identify factors independently associated with positive response to direct-acting antivirals (DAA)-based therapies. Overall 57.1% were male; 48.3% self-identified as white; 78.3% were over 50 years old; 44.1% were from the Southeast region; 47.7% had genotype 1b; and 84.5% were treated for 12 weeks. The SVR rates with DAAs ranged from 87% to 100%. Genotypes 1 and 4 had higher SVR rates (96.3–100%), and genotypes 2 and 3 had SVR of 90.6–92.2%, respectively. Treatment durations of 12 and 24 weeks were associated with an average SVR of 95.0% and 95.9%, respectively. Females were half as likely (OR 0.5; 95% CI 0.4−0.6) to have a negative response to therapy compared to males, and those with genotypes 2 and 3 were one and half fold more likely (OR 1.5–2.2; 95 CI% 0.7–2.9; 1.2–3.6 and OR 2.7–2.8; 95% CI 2.0–3.8, respectively) to not have SVR compared to genotype 1. Patients in the age-range of 50–69 years old were 1.2-fold (OR 1.2; 95% CI 0.7–1.9) more likely to not have SVR compared to other age groups, although not statistically significant. This study is the first of this magnitude to be held in a Latin-American country with high SVR results, supported by a free-of-charge universal and public health system. The high performance found in this study gives support to the Brazilian public health policy decision of adopting DAA-based therapies as a strategy to eliminate HCV by 2030.
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Affiliation(s)
- Simone Monzani Vivaldini
- Ministry of Health, Secretariat for Health Surveillance, Department of Chronic Conditions Diseases and Other Sexually Transmitted Infections, Brasília, DF, Brazil; University of Brasília (UnB), Faculty of Medicine, Center for Tropical Medicine, Brasília, DF, Brazil.
| | - Rachel Abraão Ribeiro
- Ministry of Health, Secretariat for Health Surveillance, Department of Chronic Conditions Diseases and Other Sexually Transmitted Infections, Brasília, DF, Brazil
| | - Gláucio Mosimann Júnior
- Ministry of Health, Secretariat for Health Surveillance, Department of Chronic Conditions Diseases and Other Sexually Transmitted Infections, Brasília, DF, Brazil
| | - Karen Cristine Tonini
- Ministry of Health, Secretariat for Health Surveillance, Department of Chronic Conditions Diseases and Other Sexually Transmitted Infections, Brasília, DF, Brazil
| | - Gerson Fernando Mendes Pereira
- Ministry of Health, Secretariat for Health Surveillance, Department of Chronic Conditions Diseases and Other Sexually Transmitted Infections, Brasília, DF, Brazil
| | - Wildo Navegantes de Araújo
- University of Brasília (UnB), Faculty of Medicine, Center for Tropical Medicine, Brasília, DF, Brazil; National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, RS, Brazil; University of Brasília (UnB), Faculty of Ceilândia, Brasília, DF, Brazil
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Mattingly TJ, Love BL, Khokhar B. Real World Cost-of-Illness Evidence in Hepatitis C Virus: A systematic review. PHARMACOECONOMICS 2020; 38:927-939. [PMID: 32533524 DOI: 10.1007/s40273-020-00933-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The introduction of direct-acting antivirals (DAAs) represents a potential clinical cure for hepatitis C virus (HCV) infection. Identification of costs associated with different stages of untreated disease through cost-of-illness (COI) evaluation helps inform policy decisions and cost-effectiveness analyses (CEAs). This study's objective was to review published real-world costs for patients with HCV to estimate the COI across different stages of disease progression. METHODS A literature search of EMBASE, Scopus, and PubMed from January 1, 2010 to August 31, 2019 was conducted to identify real-world evidence related to HCV. Data extraction included citation details, population, study type, costing method used, currency and inflation adjustments, and disease-specific costs. Standardized costing method categories (sum all medical, sum diagnosis specific, matching, regression, other incremental, and other total) were assigned. The risk of bias was assessed at the outcome level for influence on costs attributable to HCV. RESULTS The search strategy identified 278 studies, with 31 included in the final review after inclusion and exclusion criteria were applied. Retrospective cohorts (77%) and cross-sectional analyses (16%) were most frequently encountered. Sum Diagnosis Specific was the most common costing method (39%), followed by Regression (32%). Of the 31 studies analyzed, 35% included costs that would be included in a societal model. Costs were identified for various stages and complications related to HCV disease progression. Several studies included were determined to have a high (48%) or moderate risk (42%) of bias related to COI estimates. CONCLUSION Cost estimates for formal, informal, and non-health care services were identified in this review, but several challenges still exist in fully quantifying HCV burden. Future modeling studies including cost inputs should critically evaluate the risk of bias based on costing methods and data sources.
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Affiliation(s)
- T Joseph Mattingly
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA.
| | - Bryan L Love
- Department of Clinical Pharmacy and Outcomes Sciences, Center for Outcomes Research and Evaluation, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Bilal Khokhar
- General Dynamics Information Technology, Silver Spring, MD, USA
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