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De Greve H, Fioravanti A. Single domain antibodies from camelids in the treatment of microbial infections. Front Immunol 2024; 15:1334829. [PMID: 38827746 PMCID: PMC11140111 DOI: 10.3389/fimmu.2024.1334829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Infectious diseases continue to pose significant global health challenges. In addition to the enduring burdens of ailments like malaria and HIV, the emergence of nosocomial outbreaks driven by antibiotic-resistant pathogens underscores the ongoing threats. Furthermore, recent infectious disease crises, exemplified by the Ebola and SARS-CoV-2 outbreaks, have intensified the pursuit of more effective and efficient diagnostic and therapeutic solutions. Among the promising options, antibodies have garnered significant attention due to their favorable structural characteristics and versatile applications. Notably, nanobodies (Nbs), the smallest functional single-domain antibodies of heavy-chain only antibodies produced by camelids, exhibit remarkable capabilities in stable antigen binding. They offer unique advantages such as ease of expression and modification and enhanced stability, as well as improved hydrophilicity compared to conventional antibody fragments (antigen-binding fragments (Fab) or single-chain variable fragments (scFv)) that can aggregate due to their low solubility. Nanobodies directly target antigen epitopes or can be engineered into multivalent Nbs and Nb-fusion proteins, expanding their therapeutic potential. This review is dedicated to charting the progress in Nb research, particularly those derived from camelids, and highlighting their diverse applications in treating infectious diseases, spanning both human and animal contexts.
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Affiliation(s)
- Henri De Greve
- Structural Biology Brussels, Vrije Universiteit Brussel, Brussels, Belgium
| | - Antonella Fioravanti
- Structural Biology Brussels, Vrije Universiteit Brussel, Brussels, Belgium
- VIB-VUB Center for Structural Biology, Vrije Universiteit Brussel, Brussels, Belgium
- Fondazione ParSeC – Parco delle Scienze e della Cultura, Prato, Italy
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AlGhamdi HS, AlHabobi AA, AlQahtani RS, Ghomraoui FA, AlThiab KM, AlOun AA, AlAlwan AM, Abdelmahmoud MB, AlTraif IH, Aljumah AA. Effectiveness of generic sofosbuvir in the treatment of chronic hepatitis C virus infection in Saudi patients. Saudi Med J 2023; 44:1240-1247. [PMID: 38016752 PMCID: PMC10712790 DOI: 10.15537/smj.2023.44.12.20230481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/09/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES To assess the effectiveness of generic sofosbuvir (SOF) and branded daclatasvir (DCV) for the treatment of chronic hepatitis C virus (HCV)infected patients. METHODS This retrospective study, performed in a single center in Saudi Arabia between August 2017 and July 2022, we enrolled 140 consecutive patients with HCV who received generic SOF and branded DCV. The primary outcome was sustained virologic response at week 12 (SVR12). RESULTS The majority of the patients were female (62.1%), infected with genotype 4 (57.9%), and treatment-naïve in 120 (85.7%) patients with baseline cirrhosis in 55 (39.3%). The mean patient age was 61±13.6 years. In the intention-to-treat analysis, 131 (93.6%) patients achieved SVR12. Moreover, 85.7%, 100%, 100%, 88.9%, and 96.3% of genotypes 1a, 1b, 2, 3, and 4, respectively, achieved SVR12. In the per-protocol analysis, 131 (96.3%) patients achieved an SVR of 12. Additionally, 92.3%, 100%, 100%, 88.9%, and 98.7% of the patients with genotypes 1a, 1b, 2, 3, and 4, respectively, achieved SVR12. No HCV virologic breakthroughs occurred. In the subgroup analysis, SVR12 rates were comparable regardless of baseline characteristics, such as treatment history, cirrhosis, and hepatocellular carcinoma. Patients achieving SVR12 showed a significant improvement in post-treatment serum liver enzyme and total bilirubin levels. CONCLUSION The findings of our study confirm the effectiveness of generic sofosbuvir as a treatment option for HCV infection.
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Affiliation(s)
- Hamdan S. AlGhamdi
- From the Hepatobiliary Sciences & Organs Transplant Department (AlGhamdi, AlAlwan, Alqahtani, Aloun, Abdelmahmoud, ATtraif), Hepatology Section and From the Department of Internal Medicine (AlHabobi), King Abdulaziz Medical City of National Guard; from King Saud Bin Abdulaziz University for health sciences (AlGhamdi, AlAlwan, AlThiab); from King Abdullah International Research Centre (AlGhamdi, AlAlwan, AlThiab), Ministry of National Guard Health Affairs; From the Department of Pharmaceutical Care Services (AlThiab), King Abdulaziz Medical City of National Guard; Form the College of Medicine (AlJumah), Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; and From the Department of Internal Medicine (Ghomraoui), Sisters of Charity Hospital, Buffalo, New York, United States of America.
| | - Ali A. AlHabobi
- From the Hepatobiliary Sciences & Organs Transplant Department (AlGhamdi, AlAlwan, Alqahtani, Aloun, Abdelmahmoud, ATtraif), Hepatology Section and From the Department of Internal Medicine (AlHabobi), King Abdulaziz Medical City of National Guard; from King Saud Bin Abdulaziz University for health sciences (AlGhamdi, AlAlwan, AlThiab); from King Abdullah International Research Centre (AlGhamdi, AlAlwan, AlThiab), Ministry of National Guard Health Affairs; From the Department of Pharmaceutical Care Services (AlThiab), King Abdulaziz Medical City of National Guard; Form the College of Medicine (AlJumah), Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; and From the Department of Internal Medicine (Ghomraoui), Sisters of Charity Hospital, Buffalo, New York, United States of America.
| | - Rakan S. AlQahtani
- From the Hepatobiliary Sciences & Organs Transplant Department (AlGhamdi, AlAlwan, Alqahtani, Aloun, Abdelmahmoud, ATtraif), Hepatology Section and From the Department of Internal Medicine (AlHabobi), King Abdulaziz Medical City of National Guard; from King Saud Bin Abdulaziz University for health sciences (AlGhamdi, AlAlwan, AlThiab); from King Abdullah International Research Centre (AlGhamdi, AlAlwan, AlThiab), Ministry of National Guard Health Affairs; From the Department of Pharmaceutical Care Services (AlThiab), King Abdulaziz Medical City of National Guard; Form the College of Medicine (AlJumah), Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; and From the Department of Internal Medicine (Ghomraoui), Sisters of Charity Hospital, Buffalo, New York, United States of America.
| | - Firas A. Ghomraoui
- From the Hepatobiliary Sciences & Organs Transplant Department (AlGhamdi, AlAlwan, Alqahtani, Aloun, Abdelmahmoud, ATtraif), Hepatology Section and From the Department of Internal Medicine (AlHabobi), King Abdulaziz Medical City of National Guard; from King Saud Bin Abdulaziz University for health sciences (AlGhamdi, AlAlwan, AlThiab); from King Abdullah International Research Centre (AlGhamdi, AlAlwan, AlThiab), Ministry of National Guard Health Affairs; From the Department of Pharmaceutical Care Services (AlThiab), King Abdulaziz Medical City of National Guard; Form the College of Medicine (AlJumah), Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; and From the Department of Internal Medicine (Ghomraoui), Sisters of Charity Hospital, Buffalo, New York, United States of America.
| | - Khalefa M. AlThiab
- From the Hepatobiliary Sciences & Organs Transplant Department (AlGhamdi, AlAlwan, Alqahtani, Aloun, Abdelmahmoud, ATtraif), Hepatology Section and From the Department of Internal Medicine (AlHabobi), King Abdulaziz Medical City of National Guard; from King Saud Bin Abdulaziz University for health sciences (AlGhamdi, AlAlwan, AlThiab); from King Abdullah International Research Centre (AlGhamdi, AlAlwan, AlThiab), Ministry of National Guard Health Affairs; From the Department of Pharmaceutical Care Services (AlThiab), King Abdulaziz Medical City of National Guard; Form the College of Medicine (AlJumah), Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; and From the Department of Internal Medicine (Ghomraoui), Sisters of Charity Hospital, Buffalo, New York, United States of America.
| | - Abdulrahman A. AlOun
- From the Hepatobiliary Sciences & Organs Transplant Department (AlGhamdi, AlAlwan, Alqahtani, Aloun, Abdelmahmoud, ATtraif), Hepatology Section and From the Department of Internal Medicine (AlHabobi), King Abdulaziz Medical City of National Guard; from King Saud Bin Abdulaziz University for health sciences (AlGhamdi, AlAlwan, AlThiab); from King Abdullah International Research Centre (AlGhamdi, AlAlwan, AlThiab), Ministry of National Guard Health Affairs; From the Department of Pharmaceutical Care Services (AlThiab), King Abdulaziz Medical City of National Guard; Form the College of Medicine (AlJumah), Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; and From the Department of Internal Medicine (Ghomraoui), Sisters of Charity Hospital, Buffalo, New York, United States of America.
| | - Abduljaleel M. AlAlwan
- From the Hepatobiliary Sciences & Organs Transplant Department (AlGhamdi, AlAlwan, Alqahtani, Aloun, Abdelmahmoud, ATtraif), Hepatology Section and From the Department of Internal Medicine (AlHabobi), King Abdulaziz Medical City of National Guard; from King Saud Bin Abdulaziz University for health sciences (AlGhamdi, AlAlwan, AlThiab); from King Abdullah International Research Centre (AlGhamdi, AlAlwan, AlThiab), Ministry of National Guard Health Affairs; From the Department of Pharmaceutical Care Services (AlThiab), King Abdulaziz Medical City of National Guard; Form the College of Medicine (AlJumah), Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; and From the Department of Internal Medicine (Ghomraoui), Sisters of Charity Hospital, Buffalo, New York, United States of America.
| | - Mutaz B. Abdelmahmoud
- From the Hepatobiliary Sciences & Organs Transplant Department (AlGhamdi, AlAlwan, Alqahtani, Aloun, Abdelmahmoud, ATtraif), Hepatology Section and From the Department of Internal Medicine (AlHabobi), King Abdulaziz Medical City of National Guard; from King Saud Bin Abdulaziz University for health sciences (AlGhamdi, AlAlwan, AlThiab); from King Abdullah International Research Centre (AlGhamdi, AlAlwan, AlThiab), Ministry of National Guard Health Affairs; From the Department of Pharmaceutical Care Services (AlThiab), King Abdulaziz Medical City of National Guard; Form the College of Medicine (AlJumah), Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; and From the Department of Internal Medicine (Ghomraoui), Sisters of Charity Hospital, Buffalo, New York, United States of America.
| | - Ibrahim H. AlTraif
- From the Hepatobiliary Sciences & Organs Transplant Department (AlGhamdi, AlAlwan, Alqahtani, Aloun, Abdelmahmoud, ATtraif), Hepatology Section and From the Department of Internal Medicine (AlHabobi), King Abdulaziz Medical City of National Guard; from King Saud Bin Abdulaziz University for health sciences (AlGhamdi, AlAlwan, AlThiab); from King Abdullah International Research Centre (AlGhamdi, AlAlwan, AlThiab), Ministry of National Guard Health Affairs; From the Department of Pharmaceutical Care Services (AlThiab), King Abdulaziz Medical City of National Guard; Form the College of Medicine (AlJumah), Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; and From the Department of Internal Medicine (Ghomraoui), Sisters of Charity Hospital, Buffalo, New York, United States of America.
| | - Abdulrahman A. Aljumah
- From the Hepatobiliary Sciences & Organs Transplant Department (AlGhamdi, AlAlwan, Alqahtani, Aloun, Abdelmahmoud, ATtraif), Hepatology Section and From the Department of Internal Medicine (AlHabobi), King Abdulaziz Medical City of National Guard; from King Saud Bin Abdulaziz University for health sciences (AlGhamdi, AlAlwan, AlThiab); from King Abdullah International Research Centre (AlGhamdi, AlAlwan, AlThiab), Ministry of National Guard Health Affairs; From the Department of Pharmaceutical Care Services (AlThiab), King Abdulaziz Medical City of National Guard; Form the College of Medicine (AlJumah), Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; and From the Department of Internal Medicine (Ghomraoui), Sisters of Charity Hospital, Buffalo, New York, United States of America.
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den Boogert EM, Veldhuijzen IK, Generaal E, Prins M, Sonneveld MJ, van der Meer AJ, Zantkuijl P, van Benthem BHB, de Coul ELMO. Substantial impact of the COVID-19 pandemic on the reported number of diagnosed chronic hepatitis C virus infections in the Netherlands, 2019-2021. BMC Public Health 2023; 23:1244. [PMID: 37370036 DOI: 10.1186/s12889-023-16143-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has widespread consequences for health facilities, social contacts, and health-seeking behaviour, affecting the incidence, diagnosis and reporting of other infectious diseases. We examined trends in reported chronic hepatitis C virus (HCV) infections and associated transmission routes in the Netherlands to identify the potential impact of COVID-19 on access to healthcare (testing) services. METHODS We analysed notification data of patients with chronic HCV reported to the National Notifiable Disease Surveillance System from January 2019 until December 2021 in the Netherlands. Rates of newly reported chronic cases per 100,000 population with 95% confidence intervals (CI) were calculated, and we compared proportional changes in transmission routes for chronic HCV between 2019, 2020 and 2021. RESULTS During the study period, a total of 1,521 chronic HCV infections were reported, 72% males, median age 52 years, and an overall rate of 8.8 (95%CI 8.4-9.2) per 100,000 population. We observed an overall decline (-41.9%) in the number of reported chronic HCV in 2020 compared to 2019, with the sharpest decline in men who have sex with men (MSM)-related transmission (-57.9% in 2020, p = 0.005). CONCLUSIONS Reported cases of chronic HCV strongly declined during the COVID-19 pandemic when healthcare services were scaled down. Between February and June 2021, reported chronic HCV cases increased again, indicating a recovery of healthcare services. MSM showed the largest decline compared to other groups. Further research is needed to fully understand the impact of access to healthcare, health seeking behaviour, and (sexual) transmission risks of HCV during the COVID-19 pandemic.
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Affiliation(s)
- Elisabeth M den Boogert
- Centre for Infectious Disease Control, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Irene K Veldhuijzen
- Centre for Infectious Disease Control, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ellen Generaal
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam UMC, Amsterdam Infection and Immunity (AII), University of Amsterdam, Amsterdam, the Netherlands
| | - Milan J Sonneveld
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adriaan J van der Meer
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Birgit H B van Benthem
- Centre for Infectious Disease Control, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Eline L M Op de Coul
- Centre for Infectious Disease Control, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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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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Abdulla M, Al Ghareeb AM, Husain HAHY, Mohammed N, Al Qamish J. Effectiveness and safety of generic and brand direct acting antivirals for treatment of chronic hepatitis C. World J Clin Cases 2022; 10:12566-12577. [PMID: 36579085 PMCID: PMC9791528 DOI: 10.12998/wjcc.v10.i34.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/28/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Direct acting antivirals (DAAs) are a very effective treatment for hepatitis C virus (HCV). However, brand DAAs are expensive. The licensing of cheaper generic DAAs may address this issue, but there is a lack of clinical studies comparing the efficacy of generic vs brand DAA formulations.
AIM To compare the efficacy and safety of generic against brand DAAs for chronic hepatitis C treatment in Bahrain.
METHODS This was a retrospective observational study involving 289 patients with chronic HCV infection during 2016 to 2018. There were 149 patients who were treated with brand DAAs, while 140 patients were treated with generic DAAs. Commonly used DAAs were Ombitasvir/Paritaprevir/Ritonavir ± Dasabuvir ± Ribavirin, and Sofosbuvir/Daclatasvir ± Ribavirin. SVR at 12 wk post treatment was the main outcome variable.
RESULTS Overall, 87 patients (30.1%) had cirrhosis and 68.2% had genotype 1 HCV infection. At 12 wk post treatment, SVR was achieved by 271 (93.8%) of the patients. In patients who were treated with generic medications, 134 (95.7%) achieved SVR at 12 wk post treatment, compared to 137 (91.9%) among those treated with brand medications (P = 0.19). Having cirrhosis [odds ratio (OR): 9.41, 95% confidence interval (CI): 2.47–35.84] and having HCV genotype 3 (OR: 3.56, 95%CI: 1.03–12.38) were significant independent predictors of not achieving SVR. Alanine transaminase, gamma-glutamyl transpeptidase, and total bilirubin levels decreased significantly following therapy with both generic and brand DAAs.
CONCLUSION Generic and brand DAAs demonstrate comparable effectiveness in the treatment of chronic hepatitis C patients. Both are safe and equally effective in improving biochemical markers of hepatic inflammation.
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Affiliation(s)
- Maheeba Abdulla
- Department of Internal Medicine, Salmaniya Medical Complex, Arabian Gulf University, Manama 2904, Bahrain
| | | | | | - Nafeesa Mohammed
- Department of Internal Medicine, Salmaniya Medical Complex, Manama 2904, Bahrain
| | - Jehad Al Qamish
- Internal Medicine Department, Ibn AlNafees Hospital, Manama 3302, Bahrain
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Lashen SA, Metawea MI, Shaaban A. Direct antiviral drugs in the treatment of hepatitis C-infected rheumatoid arthritis Egyptian cohort: safety and clinical impact. Eur J Gastroenterol Hepatol 2021; 33:e239-e246. [PMID: 33252421 DOI: 10.1097/meg.0000000000002015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Data about the safety and efficacy of direct-acting antivirals (DAAs) in the treatment of hepatitis C virus (HCV) patients with concomitant rheumatoid arthritis (RA) are scarce. We assessed the impact and safety of DAAs treatment of hepatitis C on rheumatoid arthritis disease activity. PATIENTS AND METHODS Prospectively, we enrolled 65 patients with RA and HCV. A clinico-laboratory evaluation was done at baseline, including liver assessment and RA disease activity score-28 (DAS28). At 12 weeks of post-DAAs treatment, sustained virologic response (SVR12) and DAS28 were reevaluated. RESULTS The SVR12 was achieved in 59 (90.8%) patients. RA control was achieved in 47 (79.9%) patients. The post SVR12 DAS28 score was significantly lower than the baseline (3.32 ± 0.93 vs. 4.37 ± 0.90; P < 0.001). There was a significant decline in the mean values of serum anticyclic citrullinated peptide, rheumatoid factor, erythrocyte sedimentation rate and C-reactive protein after achieving an SVR12 (30.47 ± 12.37 vs. 57.61 ± 15.91 U/ml; 29.78 ± 19.58 vs. 55.14 ± 16.89 IU/ml; 17.13 ± 10.84 vs. 29.68 ± 14.32 mm/h and 5.76 ± 1.57 vs. 11.44 ± 4.13 mg/l, respectively; P < 0.05). RA activity and antirheumatic drugs were stepped-down [12 (20.3%) and 35 (59.3%) patients showed good and moderate RA response, respectively]. The baseline viral load, absence of cirrhosis and SVR12 were the only predictors of disease control (P < 0.05). No drug-related adverse events or drug-related discontinuation. CONCLUSIONS Unlike interferon, HCV elimination by DAAs significantly improves RA activity and treatment outcome with high safety and efficacy.
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Affiliation(s)
- Sameh A Lashen
- Department of Internal Medicine, Hepatology and Gastroenterology Division
| | - Marwa I Metawea
- Department of Internal Medicine, Hepatology and Gastroenterology Division
| | - Ahmed Shaaban
- Department of Internal Medicine, Rheumatology and Immunology Division, University of Alexandria, Alexandria, Egypt
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Patrick SW, Dupont WD, McNeer E, McPheeters M, Cooper WO, Aronoff DM, Osmundson S, Stein BD. Association of Individual and Community Factors With Hepatitis C Infections Among Pregnant People and Newborns. JAMA HEALTH FORUM 2021; 2:e213470. [PMID: 35977167 PMCID: PMC8727040 DOI: 10.1001/jamahealthforum.2021.3470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/05/2021] [Indexed: 12/12/2022] Open
Abstract
Importance The opioid crisis has increasingly affected pregnant people and infants. Hepatitis C virus (HCV) infections, a known complication of opioid use, grew in parallel with opioid-related complications; however, the literature informing individual and community risks associated with maternal HCV infection is sparse. Objectives To determine (1) individual and county-level factors associated with HCV among pregnant people and their newborn infants, and (2) how county-level factors influence individual risk among the highest risk individuals. Design Setting and Participants This time-series analysis of retrospective, repeated cross-sectional data included pregnant people in all US counties from 2009 to 2019. We constructed mixed-effects logistic regression models to explore the association between HCV infection and individual and county-level covariates. Analyses were conducted between June 2019 and September 2021. Exposures Individual-level: race and ethnicity, education, marital status, insurance type; county-level: rurality, employment, density of obstetricians. Main Outcomes and Measures Hepatitis C virus as indicated on the newborn's birth certificate. Results Between 2009 and 2019, there were 39 380 122 pregnant people who met inclusion criteria, among whom 138 343 (0.4%) were diagnosed with HCV. People with HCV were more likely to be White (79.9% vs 53.5%), American Indian or Alaska Native (AI/AN) (2.9% vs 0.9%), be without a 4-year degree (93.2% vs 68.6%), and be unmarried (73.7% vs 38.8%). The rate (per 1000 live births) of HCV among pregnant people increased from 1.8 to 5.1. In adjusted analyses, the following factors were associated with higher rates of HCV: individuals identified as White (adjusted odds ratio [aOR], 7.37; 95% CI, 7.20-7.55) and AI/AN (aOR, 7.94; 95% CI, 7.58-8.31) compared with Black individuals, those without a 4-year degree (aOR, 3.19; 95% CI, 3.11-3.28), those with Medicaid vs private insurance (aOR, 3.27; 95% CI, 3.21-3.33), and those who were unmarried (aOR, 2.80; 95% CI, 2.76-2.84); whereas, rural residence, higher rates of employment, and greater density of obstetricians was associated with lower risk of HCV. Among individuals at the highest risk of HCV, higher levels of county employment, accounting for other factors, were associated with less of a rise in HCV infections over time. Conclusions and Relevance In this cross-sectional study, maternal and newborn HCV infections increased substantially between 2009 and 2019, disproportionately among White and AI/AN people without a 4-year degree. County-level factors, including higher levels of employment, were associated with lower individual risks of acquiring the virus.
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Affiliation(s)
- Stephen W. Patrick
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee,RAND Corporation, Pittsburgh, Pennsylvania
| | - William D. Dupont
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth McNeer
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melissa McPheeters
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William O. Cooper
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David M. Aronoff
- Department of Medicine, Division of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah Osmundson
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bradley D. Stein
- RAND Corporation, Pittsburgh, Pennsylvania,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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8
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Sharafi H, Behnava B, Azizi-Saraji A, Namvar A, Anvar A, Salimi S, Alavian SM. Treatment of hepatitis C virus infection with direct-acting antiviral agent-based regimens in Iranian patients with hereditary bleeding disorders. Virol J 2021; 18:199. [PMID: 34620204 PMCID: PMC8496886 DOI: 10.1186/s12985-021-01659-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic hepatitis C (CHC) is one of the most important comorbidities in patients with hereditary bleeding disorders (HBD). The present study aimed at evaluating the effectiveness of direct-acting antiviral agent (DAA)-based interferon-free HCV antiviral regimens in patients with HBD. PATIENTS AND METHODS The present study was performed on the patients with HBD and CHC between 2015 and 2019. Sofosbuvir-based interferon-free regimens with or without ribavirin were prescribed to treat HCV infection. The main endpoint of the study was to determine the sustained virologic response (SVR), assessed 12 weeks after the completion of treatment. RESULTS A total of 147 patients with a mean age of 41.1 years were enrolled in the study; 4.1% of them were co-infected with HIV, 25.2% had cirrhosis, and 76.9% of them were diagnosed with hemophilia A. HCV genotype-1 includes the largest number (68.1%) of patients. 46.3% of patients were treatment-naïve and others had a treatment history with interferon-based regimens. Out of 147 patients, 15 patients were lost to follow-up during treatment or for SVR evaluation or discontinued treatment. 132 subjects completed treatment and were evaluated for SVR, 12 weeks after the completion of treatment. All of the patients achieved SVR 12 (SVR rate: 100%, 95% CI 97.2-100%). CONCLUSION Hepatitis C DAA-based regimens are the effective treatments for CHC in patients with HBD, regardless of the treatment modifiers such as previous treatment experience, cirrhosis, HIV co-infection, and HCV genotype.
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Affiliation(s)
| | - Bita Behnava
- Middle East Liver Diseases (MELD) Center, Tehran, Iran
| | | | - Ali Namvar
- Iranian Comprehensive Haemophilia Care Centre, Tehran, Iran
| | - Ali Anvar
- Iranian Comprehensive Haemophilia Care Centre, Tehran, Iran
| | - Shima Salimi
- Middle East Liver Diseases (MELD) Center, Tehran, Iran
| | - Seyed Moayed Alavian
- Middle East Liver Diseases (MELD) Center, Tehran, Iran.
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.
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9
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Impact of DAA-Based Regimens on HCV-Related Extra-Hepatic Damage: A Narrative Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1323:115-147. [PMID: 33326112 DOI: 10.1007/5584_2020_604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Two-third of patients with chronic hepatitis C show extrahepatic manifestations due to HCV infection of B lymphocytes, such as mixed cryoglobulinemia and non-Hodgkin B-cell lymphoma, or develop a chronic inflammatory status that may favor the development of adverse cardiovascular events, kidney diseases or metabolic abnormalities.DAAs treatments induce HCV eradication in 95% of treated patients, which also improves the clinical course of extrahepatic manifestations, but with some limitations. After HCV eradication a good compensation of T2DM has been observed, but doubts persist about the possibility of obtaining a stable reduction in fasting glucose and HbA1c levels.Chronic HCV infection is associated with low total and LDL cholesterol serum levels, which however increase significantly after HCV elimination, possibly due to the disruption of HCV/lipid metabolism interaction. Despite this adverse effect, HCV eradication exerts a favorable action on cardiovascular system, possibly by eliminating numerous other harmful effects exerted by HCV on this system.DAA treatment is also indicated for the treatment of patients with mixed cryoglobulinemia syndrome, since HCV eradication results in symptom reduction and, in particular, is effective in cryoglobulinemic vasculitis. Furthermore, HCV eradication exerts a favorable action on HCV-related lymphoproliferative disorders, with frequent remission or reduction of clinical manifestations.There is also evidence that HCV clearance may improve impaired renal functions, but same conflicting data persist on the effect of some DAAs on eGFR.
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10
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Decentralised hepatitis C testing and treatment in rural Cambodia: evaluation of a simplified service model integrated in an existing public health system. Lancet Gastroenterol Hepatol 2021; 6:371-380. [PMID: 33743883 DOI: 10.1016/s2468-1253(21)00012-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Direct-acting antiviral treatment for hepatitis C virus (HCV) has provided the opportunity for simplified models of care delivered in decentralised settings by non-specialist clinical personnel. However, in low-income and middle-income countries, increasing overall access to HCV care remains an ongoing issue, particularly for populations outside of urban centres. We therefore aimed to implement a simplified model of HCV care via decentralised health services within a rural health operational district in Battambang province, Cambodia. METHODS The study cohort included adult residents (≥18 years) of the health operational district of Moung Russei who were voluntarily screened at 13 local health centres. Serology testing was done by a rapid diagnostic test using SD Bioline HCV (SD Bioline HCV, Standard Diagnostics, South Korea) with capillary blood. HCV viral load testing was done by GeneXpert (Cepheid, Sunnyvale, CA, USA). Viraemic patients (HCV viral load ≥10 IU/mL) received pretreatment assessment by a general physician and minimal treatment evaluation tests at the health operational district referral hospital. Viraemic patients who did not have additional complications received all HCV care follow-up at the local health centres, provided by nursing staff, and patients who had decompensated cirrhosis, previously treated with a direct-acting antiviral, HBV co-infection, or other comorbidities requiring observation continued receiving care at the referral hospital with a general physician. Patients deemed eligible for treatment were prescribed oral sofosbuvir (400 mg) and daclatasvir (60 mg) once a day for 12 weeks, or 24 weeks for patients with decompensated cirrhosis or those previously treated with a direct-acting antiviral. HCV cure was defined as sustained virological response at 12 weeks after treatment (HCV viral load <10 IU/mL). Patients were assessed for serious and non-serious adverse events at any time between treatment initiation and 12 weeks post-treatment testing. FINDINGS Between March 12, 2018, and Jan 18, 2019, 10 425 residents (ie, 7·6% of the estimated 136 571 adults in the health operational district of Moung Russei) were screened. Of those patients screened, the median age was 44 years (IQR 31-55) and 778 (7·5%) were HCV-antibody positive. 761 (97·8%) of 778 antibody-positive patients received HCV viral load testing, and 540 (71·0%) of those tested were HCV viraemic. Among these 540 patients, linkage to treatment and follow-up care was high, with 533 (98·7%) attending a baseline consultation at the HCV clinic, of whom 530 (99·4%) initiated treatment. 485 (91·5%) of 530 patients who initiated treatment received follow-up at a health centre and 45 (8·5%) were followed up at the referral hospital. Of the 530 patients who initiated direct-acting antiviral therapy, 515 (97·2%) completed treatment. Subsequently, 466 (90·5%) of 515 patients completed follow-up, and 459 (98·5%) of 466 achieved a sustained virological response at 12 weeks after treatment. Two (0·4%) adverse events (fatigue [n=1] and stomach upset [n=1]) and five (0·9%) serious adverse events (infection [n=2], cardiovascular disease [n=1], and panic attack [n=1], with data missing for one of the causes of serious adverse events) were reported among patients who initiated treatment. All serious adverse events were deemed to be unrelated to therapy. INTERPRETATION This pilot project showed that a highly simplified, decentralised model of HCV care can be integrated within a rural public health system in a low-income or middle-income country, while maintaining high patient retention, treatment efficacy, and safety. The project delivered care via accessible, decentralised primary health centres, using non-specialist clinical staff, thereby enhancing the efficient use of limited resources and maximising the potential to test and treat individuals living with HCV infection. FUNDING Médecins Sans Frontières.
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11
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Castro Filho EC, Piedade J, Castro R, Luz PM, Fernandes F, Grinsztejn B, Veloso VG, Pereira GH, Perazzo H. Effectiveness of direct-acting agents for chronic hepatitis C treatment in South America: A systematic review and meta-analysis. J Viral Hepat 2020; 27:1396-1407. [PMID: 32706518 DOI: 10.1111/jvh.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/05/2020] [Accepted: 07/10/2020] [Indexed: 12/09/2022]
Abstract
The effectiveness of direct-acting agents (DAAs) for hepatitis C treatment in limited-resource settings remains unclear. We estimated the pooled sustained virological response rates of DAA therapy in South America. We searched online databases for studies that reported 12-week sustained virological response (SVR12) to hepatitis C virus (HCV) treatment in individuals living in South America. Pooled SVR12 in intention-to-treat (ITT) and per-protocol were estimated. Additionally, using all studies with available data, the pooled relative risk (RR) of SVR12 using a random-effects model (DerSimonian-Laird) was estimated to compare effectiveness of DAAs in patients with or without cirrhosis, HIV co-infection or previous HCV therapy. Heterogeneity was assessed using the I2 statistics. We identified 20 studies [14 manuscripts and 6 conference abstracts] comprising 7393 individuals from five countries [Brazil (n = 11), Argentina (n = 4), Chile (n = 1), Colombia (n = 1) and Peru (n = 1)] and two South-American collaborations. The pooled overall SVR12 rates [95% confidence interval (CI)] were 92.6% [90.2-94.7] and 95.5% [94.3-96.6] by ITT (11 studies; n = 4,153; I2 = 84.2%) and per-protocol analysis (15 studies; n = 4,833; I2 = 64.5%), respectively. The RR of SVR12 was similar in patients with or without HIV co-infection [4 studies; RR = 1.03 (0.99-1.07)] and those naive compared with treatment experimented-individuals [9 studies; RR = 1.01 (1.00-1.03)], but significantly higher in patients without cirrhosis compared with those with cirrhosis [11 studies; RR = 1.04 (1.02-1.05), P < .001]. DAAs are highly effective for HCV treatment in South America. The use of DAAs should be considered in limited-resource settings to decrease the burden of liver disease in HCV-infected patients. PROSPERO[CRD 42019134603].
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Affiliation(s)
- Elio C Castro Filho
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, Brazil
| | - Juliana Piedade
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, Brazil.,Hospital Federal de Bonsucesso, Departamento de Gastroenterologia & Hepatologia, Rio de Janeiro, Brazil
| | - Rodolfo Castro
- Fundação Oswaldo Cruz (FIOCRUZ), Escola Nacional de Saúde Pública (ENSP), Rio de Janeiro, Brazil.,Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Instituto de Saúde Coletiva (ISC), Rio de Janeiro, Brazil
| | - Paula M Luz
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, Brazil
| | - Flavia Fernandes
- Hospital Federal de Bonsucesso, Departamento de Gastroenterologia & Hepatologia, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, Brazil
| | - Gustavo Henrique Pereira
- Hospital Federal de Bonsucesso, Departamento de Gastroenterologia & Hepatologia, Rio de Janeiro, Brazil
| | - Hugo Perazzo
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, Brazil
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12
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Hamada Y, Uchida M, Arai S, Yamazaki K, Takeda M, Arai K, Nakamura T, Suzuki T, Ishii I. Analysis of patients’ request to switch from a generic drug to the original drug in external prescriptions. J Pharm Health Care Sci 2020; 6:27. [PMID: 33292744 PMCID: PMC7716439 DOI: 10.1186/s40780-020-00180-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/26/2020] [Indexed: 12/04/2022] Open
Abstract
Background Generic drugs are heavily promoted in Japan. The aim of this retrospective single-center study was to clarify whether the frequency and reason that patients request a switch from a generic drug to the original drug differ according to therapeutic category and dosage form. Methods This study was performed at Chiba University Hospital. Prescription inquiries about 121 generic drugs from community pharmacies over a 3-year period (from July 2014 to June 2017) were analyzed. Results Approximately 30% of the requests were related to the efficacy, safety, and comfort of the generic drug. The most cited motive was “patient’s desire with no reason given” at 44.5%. According to multiple logistic regression analysis, therapeutic categories and dosage forms were associated with the requests. The median request frequency differed according to therapeutic category and dosage form. The frequency was highest for “agents affecting the central nervous system” and “tablets and capsules”, respectively. Among the therapeutic categories, “agents affecting the central nervous system” had the highest median number of requests related to “decreased effectiveness”; “cardiovascular agents” had the highest median number of requests related to “physician’s instruction”; and “agents for the epidermis” had the highest median number of requests related to “uncomfortable to use”. Among dosage forms, the odds ratio for patients’ original drug request for “liniment and patch” was about 1.5 times that for “tablets and capsules”. “Liniment and patch” had the highest median frequency of requests related to “decreased effectiveness”, “uncomfortable to use”, and “patient’s desire with no reason given”. Conclusions The request frequency and reason differed according to therapeutic category and dosage form. Pharmacists should advise each patient properly about the choice and switching of drug brands, taking into account the therapeutic category and dosage form, especially liniments and patches.
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13
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Pawlotsky JM, Ramers CB, Dillon JF, Feld JJ, Lazarus JV. Simplification of Care for Chronic Hepatitis C Virus Infection. Semin Liver Dis 2020; 40:392-402. [PMID: 32725611 DOI: 10.1055/s-0040-1713657] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In 2016, the World Health Organization (WHO) set a target for eliminating viral hepatitis as a major public health threat by 2030. However, while today's highly effective and well-tolerated pangenotypic direct-acting antiviral regimens have maximized simplification of hepatitis C virus (HCV) treatment, there remain a plethora of barriers to HCV screening, diagnosis, and linkage to care. As of 2017, only 19% of the estimated 71 million individuals living with chronic HCV worldwide were diagnosed and in 2015 to 2016, only 21% of diagnosed individuals had accessed treatment. Simplification and decentralization of the HCV care cascade would bolster patient engagement and support the considerable scale-up needed to achieve WHO targets. Recent developments in HCV screening and diagnosis, together with reduced pretreatment assessment and on-treatment monitoring requirements, can further streamline the care continuum, ensuring patients are linked to care quickly and earlier in the disease course, and minimize clinic visits.
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Affiliation(s)
- Jean-Michel Pawlotsky
- Department of Virology, National Reference Center for Viral Hepatitis B, C and D, Henri Mondor Hospital, University of Paris-Est-INSERM U955, Créteil, France
| | - Christian B Ramers
- Division of Infectious Diseases, Department of Medicine, UC San Diego School of Medicine, La Jolla, California
| | - John F Dillon
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, Sandra Rotman Centre for Global Health, Toronto, ON, Canada
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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14
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Nguyen HA, Cooke GS, Day JN, Flower B, Phuong LT, Hung TM, Dung NT, Khoa DB, Hung LM, Kestelyn E, Thwaites GE, Chau NVV, Turner HC. The direct-medical costs associated with interferon-based treatment for Hepatitis C in Vietnam. Wellcome Open Res 2020; 4:129. [PMID: 32734002 PMCID: PMC7372532 DOI: 10.12688/wellcomeopenres.15408.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 02/02/2023] Open
Abstract
Background: Injectable interferon-based therapies have been used to treat hepatitis C virus (HCV) infection since 1991. International guidelines have now moved away from interferon-based therapy towards direct-acting antiviral (DAA) tablet regimens, because of their superior efficacy, excellent side-effect profiles, and ease of administration. Initially DAA drugs were prohibitively expensive for most healthcare systems. Access is now improving through the procurement of low-cost, generic DAAs acquired through voluntary licenses. However, HCV treatment costs vary widely, and many countries are struggling with DAA treatment scale-up. This is not helped by the limited cost data and economic evaluations from low- and middle-income countries to support HCV policy decisions. We conducted a detailed analysis of the costs of treating chronic HCV infection with interferon-based therapy in Vietnam. Understanding these costs is important for performing necessary economic evaluations of novel treatment strategies. Methods: We conducted an analysis of the direct medical costs of treating HCV infection with interferon alpha (IFN) and pegylated-interferon alpha (Peg-IFN), in combination with ribavirin, from the health sector perspective at the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, in 2017. Results: The total cost of the IFN treatment regimen was estimated to range between US$1,120 and US$1,962. The total cost of the Peg-IFN treatment regimen was between US$2,156 and US$5,887. Drug expenses were the biggest contributor to the total treatment cost (54-89%) and were much higher for the Peg-IFN regimen. Conclusions: We found that treating HCV with IFN or Peg-IFN resulted in significant direct medical costs. Of concern, we found that all patients incurred substantial out-of-pocket costs, including those receiving the maximum level of support from the national health insurance programme. This cost data highlights the potential savings and importance of increased access to generic DAAs in low- and middle-income countries and will be useful within future economic evaluations.
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Affiliation(s)
| | - Graham S. Cooke
- Division of Infectious Diseases, Imperial College London, London, UK
| | - Jeremy N. Day
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Barnaby Flower
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
| | | | - Trinh Manh Hung
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
| | | | - Dao Bach Khoa
- Hospital for Tropical Diseases, Ho Chi Minh, Vietnam
| | - Le Manh Hung
- Hospital for Tropical Diseases, Ho Chi Minh, Vietnam
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Guy E. Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - SEARCH Investigators
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
- Division of Infectious Diseases, Imperial College London, London, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Hospital for Tropical Diseases, Ho Chi Minh, Vietnam
| | - Hugo C. Turner
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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