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Huynh T, Hu KQ. Excellent Safety and Sustained Virologic Response to Direct-Acting Antivirals Treatment in HCV-Infected Geriatric Patients: A Real-World Data. Dig Dis Sci 2021; 66:1327-1334. [PMID: 32405981 DOI: 10.1007/s10620-020-06286-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Direct-acting antivirals (DAAs) are current standard of HCV treatment (Rx). However, data remain lacking on real-world safety, patterns of biochemical, virologic responses, and sustained virologic response (SVR12) rate in geriatric patients. AIMS The present study assessed clinical presentation, safety, SVR12 rate, dynamic changes in HCV RNA, ALT, and AFP in geriatric patients (age ≥ 65 year old, G1) versus non-geriatric patients (G2) with chronic hepatitis C and received DAA treatment. METHODS This was a single-center, retrospective study on 183 patients with DAA Rx and 12-week post-Rx follow-up. RESULTS There were no significant differences in patterns of biochemical and virologic responses between the two groups. Undetectable HCV RNA rates were 67.2% versus 75.7% (p = 0.22) and 77.3% versus 84.3% (p = 0.24) at Rx week 2 and Rx week 4, respectively. The SVR12 rate was comparable in 2 groups, 94.1% (G1) versus 95.7% (G2, p = 0.64). ALT normalization rates were 91.2% versus 91.3% (p = 0.98), 92.6% versus 93.9% (p = 0.74), and 97.1% versus 97.4% (p = 0.89) at Rx week 2, post-Rx week12, and post-Rx week 24, respectively. AFP normalization was lower in G1 with 89.7% versus 95.7% (p = 0.12), 77.9% versus 87.8% (p = 0.08), and 79.4% versus 92.2% (p = 0.01), at Rx week 2, and post-Rx week 12, and post-Rx week 24, respectively. Both groups showed similar side effects profile including fatigue 11.8% versus 12.2% (p = 0.93) and headache 11.8% versus 13.9% (p = 0.68). CONCLUSION Based on our real-world data, geriatric patients had excellent and comparable treatment outcomes with non-geriatric patients in safety and SVR12 rates to different DAA regimens.
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Affiliation(s)
- Tung Huynh
- Department of Pharmacy, University of California Irvine Medical Center, Orange, CA, USA
| | - Ke-Qin Hu
- Division of Gastroenterology and Hepatology, University of California Irvine, School of Medicine, 101 The City Drive, Building 56, Ste. 801, Orange, CA, 92868, USA.
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Sofosbuvir and Ribavirin Combination Therapy Response in Various Hepatitis C Virus Genotypes in Peshawar, Khyber Pakhtunkhwa. Jundishapur J Microbiol 2020. [DOI: 10.5812/jjm.99625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Approximately 3% of the population worldwide is infected with Hepatitis C Virus (HCV). Different regimens have been used to treat HCV, each of which has its side effects and efficacy. Sofosbuvir, a direct-acting antiviral drug, has replaced all previous regimens with the highest response rate. However, its response is not fully covered in Pakistan, especially Khyber Pakhtunkhwa. Objectives: The study aimed to examine the response to Sofosbuvir and Ribavirin combination therapy in chronic HCV patients infected with various HCV genotypes. Methods: This study was conducted in Tertiary Care Hospitals, Peshawar, Pakistan. The patients were enrolled from January 2016 to March 2017. A total of 80 patients (57 naïve and 23 non-responder) were enrolled in this study. The age range was 16 - 70 years, and the mean age was 36 ± 2 years. Genotyping, biochemical profile, PCR tests, and liver ultrasounds were done for all of the enrolled subjects at the start and end of therapy. All patients were given direct-acting antiviral drugs for six months and then, the end of treatment response was noted. Results: A total of 80 subjects with HCV infection took part in the study, including 57 (71.25%) treatment-naïve and 23 (28.75%) treatment non-responding patients. The end of therapy response was reported after 24 weeks of treatment. Among the 80 patients, 72 (90%) patients achieved the end of therapy response. The highest end of therapy response (100%) was noted in genotype 1 and mixed genotypes and patients with normal liver ultrasound. The lowest end of therapy response (70%) was found in un-type genotype and patients with an abnormal texture of liver ultrasound. The end of therapy response rate was higher in females than in males. Conclusions: In the current study, the minimal response was found in un-type genotypes and genotypes that did not respond to INF, as compared to treatment-naïve subjects. Further research is needed to understand the relevant host and viral factors, with particular attention to relapsed patients and non-responders that are difficult to treat in the Pakistani population.
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The Role of Autophagy in Interferon/Ribavirin Responders and Non-Responders with Hepatitis C Virus Infection. Jundishapur J Microbiol 2020. [DOI: 10.5812/jjm.92560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Huynh T, Hu KQ. Direct acting antiviral-induced dynamic reduction of serum α fetoprotein in hepatitis C patients without hepatocellular carcinoma. Front Med 2019; 13:658-666. [PMID: 31655955 DOI: 10.1007/s11684-019-0707-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022]
Abstract
Direct acting antiviral (DAA) treatments may reduce the elevated α fetoprotein (AFP), but data on how these treatments affect elevated AFP in patients with chronic hepatitis C (CHC) remain insufficient. In the present study, the frequency of baseline AFP elevations and their related factors, AFP dynamics during and after DAA treatment, and factors associated with AFP reduction was assessed. This retrospective study included 141 patients with CHC without hepatocellular carcinoma who received DAA and achieved sustained virological response. The details are as follows: mean post-treatment follow-up was 99 weeks (12-213); mean age, 57.8 years old; 52%, males; 79%, genotype (GT) 1; and 47%, cirrhosis. Pre-treatment AFP elevation (> 5.5 ng/mL) was seen in 48.2% patients. On multivariate analysis, baseline AFP > 5.5 was associated with the presence of cirrhosis (P =0.001), coexisting non-alcoholic steatohepatitis (NASH) (P = 0.035), and GT 1 (P = 0.029). AFP normalization was seen in 28.2% patients at treatment week 2, in 52% at the end of treatment, and in 73.4% at the end of follow-up. Post-treatment week 24 AFP normalization was associated with the absence of cirrhosis (P = 0.003), Child-Pugh score < 6 (P = 0.015), and baseline AFP < 10 (P = 0.015). AFP elevation is common in patients with CHC and independently associated with NASH, cirrhosis, and GT 1. DAA treatment resulted in AFP normalization as early as treatment week 2. Post-treatment week 24 AFP normalization is independently associated with the absence of cirrhosis, Child-Pugh score < 6, and baseline AFP < 10.
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Affiliation(s)
- Tung Huynh
- Department of Pharmacy, University of California, Irvine, School of Medicine, Orange, CA, 92868, USA
| | - Ke-Qin Hu
- Division of Gastroenterology and Hepatology, University of California, Irvine, School of Medicine, Orange, CA, 92868, USA.
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Mohamed AA, Eljaky AM, Abdelsameea EM, Fouad TR, El-Ezawy HEDM. Prevalence and effect of occult hepatitis C infection in patients with persistent liver enzyme elevation after achieving 24 weeks of sustained virological response. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2019. [DOI: 10.4103/ejim.ejim_24_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cost-effectiveness and budgetary impact of HCV treatment with direct-acting antivirals in India including the risk of reinfection. PLoS One 2019; 14:e0217964. [PMID: 31170246 PMCID: PMC6553784 DOI: 10.1371/journal.pone.0217964] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 05/22/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND HCV direct-acting antivirals (DAAs) are produced in India at low cost. However, concerns surrounding reinfection and budgetary impact limit treatment scale-up in India. We evaluate the cost-effectiveness and budgetary impact of HCV treatment in India, including reinfection. METHODS A closed cohort Markov model of HCV disease progression, treatment, and reinfection was parameterized. We compared treatment by fibrosis stage (F2-F4 or F0-F4) to no treatment from a health care payer perspective. Costs (2017 USD$, based on India-specific data) and health utilities (in quality-adjusted life years, QALYs) were attached to each health state. We assumed DAAs with 90% sustained viral response at $900/treatment and 1%/year reinfection, varied in the sensitivity analysis from 0.1-15%. We deemed the intervention cost-effective if the incremental cost-effectiveness ratio (ICER) fell below India's per capita GDP ($1,709). We assessed the budgetary impact of treating all diagnosed individuals. RESULTS HCV treatment for diagnosed F2-F4 individuals was cost-saving (net costs -$2,881 and net QALYs 3.18/person treated; negative ICER) compared to no treatment. HCV treatment remained cost-saving with reinfection rates of 15%/year. Treating all diagnosed individuals was likely cost-effective compared to delay until F2 (mean ICER $1,586/QALY gained, 67% of simulations falling under the $1,709 threshold) with 1%/year reinfection. For all scenarios, annual retesting for reinfection was more cost-effective than the current policy (one-time retest). Treating all diagnosed individuals and reinfections results in net costs of $445-1,334 million over 5 years (<0.25% of total health care expenditure over 5 years), and cost-savings within 14 years. CONCLUSIONS HCV treatment was highly cost-effective in India, despite reinfection. Annual retesting for reinfection was cost-effective, supporting a policy change towards more frequent retesting. A comprehensive HCV treatment scale-up plan is warranted in India.
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Petruzziello A, Loquercio G, Sabatino R, Balaban DV, Ullah Khan N, Piccirillo M, Rodrigo L, di Capua L, Guzzo A, Labonia F, Botti G. Prevalence of Hepatitis C virus genotypes in nine selected European countries: A systematic review. J Clin Lab Anal 2019; 33:e22876. [PMID: 30843304 PMCID: PMC6595292 DOI: 10.1002/jcla.22876,] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a global health problem especially for its increasing level of mortality. Detailed knowledge of HCV genotypes prevalence has clinical relevance since the efficacy of therapies is impacted by genotypes and subtypes distribution. Moreover, HCV exhibits a great genetic variability regionally. To date, there are no published studies assessing HCV genotypes distribution in specific countries of the Mediterranean basin. The aim of this study was to review data published from 2000 to 2017 with the purpose to estimate genotypes distribution of HCV infection in nine European countries all located in the Mediterranean basin. METHODS A systematic research of peer-reviewed journals indexed in PubMed, Scopus, and EMBASE databases selected if containing data regarding distribution of HCV genotypes in nine selected European countries (Albania, Bosnia, Croatia, France, Greece, Italy, Montenegro, Slovenia, and Spain) was performed. RESULTS Genotype 1 is the most common (61.0%), ranging from 80.0% in Croatia to 46.0% in Greece, followed by genotype 3 (20.0%), varying from 38.0% in Slovenia to 7.0% and 8.0%, respectively, in Italy and in Albania and by genotype 4 (10.0%) that shows an increase of 1.1% with respect to data obtained till 2014 probably due to the increasing migrants arrivals to Southern Europe. G2, the fourth most frequent genotype (8.5%), particularly common in Italy (27.0%) and Albania (18.0%) might be probably introduced in Southern Italy as a result of Albanian campaign during Second World War and more and more increased by the migration flows from Albania to Italy in the 90s. CONCLUSION Epidemiology of HCV infection shows a high variability across the European countries that border the Mediterranean Sea. HCV genotyping is a relevant tool to monitor the dynamic process influenced by both evolving transmission trends and new migration flows on HCV scenario.
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Affiliation(s)
| | - Giovanna Loquercio
- SSD Virology and Molecular Biology, Department of Diagnostic AreaIstituto Nazionale Tumori – Fondazione “G. Pascale”, IRCCS ItaliaNaplesItaly
| | - Rocco Sabatino
- SSD Virology and Molecular Biology, Department of Diagnostic AreaIstituto Nazionale Tumori – Fondazione “G. Pascale”, IRCCS ItaliaNaplesItaly
| | - Daniel Vasile Balaban
- Carol Davila" University of Medicine and Pharmacy, "Dr. Carol Davila" Central Military Emergency University HospitalBucharestRomania
| | - Najeeb Ullah Khan
- Institute of Biotechnology and Genetic Engineering (Health Davison)The University of AgriculturePeshawarPakistan
| | - Mauro Piccirillo
- Hepatobiliar and Pancreatic Unit, Department of Surgical OncologyIstituto Nazionale Tumori–Fondazione “G. Pascale”IRCCS ItaliaNaplesItaly
| | - Luis Rodrigo
- Gastroenterology ServiceHospital Universitario Central de Asturias, University of OviedoOviedoSpain
| | - Lucia di Capua
- SSD Virology and Molecular Biology, Department of Diagnostic AreaIstituto Nazionale Tumori – Fondazione “G. Pascale”, IRCCS ItaliaNaplesItaly
| | - Annunziata Guzzo
- SSD Virology and Molecular Biology, Department of Diagnostic AreaIstituto Nazionale Tumori – Fondazione “G. Pascale”, IRCCS ItaliaNaplesItaly
| | - Francesco Labonia
- SSD Virology and Molecular Biology, Department of Diagnostic AreaIstituto Nazionale Tumori – Fondazione “G. Pascale”, IRCCS ItaliaNaplesItaly
| | - Gerardo Botti
- Scientific DirectorIRCCS Fondazione PascaleNaplesItaly
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Petruzziello A, Loquercio G, Sabatino R, Balaban DV, Ullah Khan N, Piccirillo M, Rodrigo L, di Capua L, Guzzo A, Labonia F, Botti G. Prevalence of Hepatitis C virus genotypes in nine selected European countries: A systematic review. J Clin Lab Anal 2019; 33:e22876. [PMID: 30843304 PMCID: PMC6595292 DOI: 10.1002/jcla.22876] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a global health problem especially for its increasing level of mortality. Detailed knowledge of HCV genotypes prevalence has clinical relevance since the efficacy of therapies is impacted by genotypes and subtypes distribution. Moreover, HCV exhibits a great genetic variability regionally. To date, there are no published studies assessing HCV genotypes distribution in specific countries of the Mediterranean basin. The aim of this study was to review data published from 2000 to 2017 with the purpose to estimate genotypes distribution of HCV infection in nine European countries all located in the Mediterranean basin. METHODS A systematic research of peer-reviewed journals indexed in PubMed, Scopus, and EMBASE databases selected if containing data regarding distribution of HCV genotypes in nine selected European countries (Albania, Bosnia, Croatia, France, Greece, Italy, Montenegro, Slovenia, and Spain) was performed. RESULTS Genotype 1 is the most common (61.0%), ranging from 80.0% in Croatia to 46.0% in Greece, followed by genotype 3 (20.0%), varying from 38.0% in Slovenia to 7.0% and 8.0%, respectively, in Italy and in Albania and by genotype 4 (10.0%) that shows an increase of 1.1% with respect to data obtained till 2014 probably due to the increasing migrants arrivals to Southern Europe. G2, the fourth most frequent genotype (8.5%), particularly common in Italy (27.0%) and Albania (18.0%) might be probably introduced in Southern Italy as a result of Albanian campaign during Second World War and more and more increased by the migration flows from Albania to Italy in the 90s. CONCLUSION Epidemiology of HCV infection shows a high variability across the European countries that border the Mediterranean Sea. HCV genotyping is a relevant tool to monitor the dynamic process influenced by both evolving transmission trends and new migration flows on HCV scenario.
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Affiliation(s)
| | - Giovanna Loquercio
- SSD Virology and Molecular Biology, Department of Diagnostic AreaIstituto Nazionale Tumori – Fondazione “G. Pascale”, IRCCS ItaliaNaplesItaly
| | - Rocco Sabatino
- SSD Virology and Molecular Biology, Department of Diagnostic AreaIstituto Nazionale Tumori – Fondazione “G. Pascale”, IRCCS ItaliaNaplesItaly
| | - Daniel Vasile Balaban
- Carol Davila" University of Medicine and Pharmacy, "Dr. Carol Davila" Central Military Emergency University HospitalBucharestRomania
| | - Najeeb Ullah Khan
- Institute of Biotechnology and Genetic Engineering (Health Davison)The University of AgriculturePeshawarPakistan
| | - Mauro Piccirillo
- Hepatobiliar and Pancreatic Unit, Department of Surgical OncologyIstituto Nazionale Tumori–Fondazione “G. Pascale”IRCCS ItaliaNaplesItaly
| | - Luis Rodrigo
- Gastroenterology ServiceHospital Universitario Central de Asturias, University of OviedoOviedoSpain
| | - Lucia di Capua
- SSD Virology and Molecular Biology, Department of Diagnostic AreaIstituto Nazionale Tumori – Fondazione “G. Pascale”, IRCCS ItaliaNaplesItaly
| | - Annunziata Guzzo
- SSD Virology and Molecular Biology, Department of Diagnostic AreaIstituto Nazionale Tumori – Fondazione “G. Pascale”, IRCCS ItaliaNaplesItaly
| | - Francesco Labonia
- SSD Virology and Molecular Biology, Department of Diagnostic AreaIstituto Nazionale Tumori – Fondazione “G. Pascale”, IRCCS ItaliaNaplesItaly
| | - Gerardo Botti
- Scientific DirectorIRCCS Fondazione PascaleNaplesItaly
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9
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Buchanan-Hughes AM, Buti M, Hanman K, Langford B, Wright M, Eddowes LA. Health state utility values measured using the EuroQol 5-dimensions questionnaire in adults with chronic hepatitis C: a systematic literature review and meta-analysis. Qual Life Res 2018; 28:297-319. [PMID: 30225787 DOI: 10.1007/s11136-018-1992-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Chronic hepatitis C infection and its treatment can considerably affect patients' health-related quality-of-life (HRQoL). This study aimed to identify and summarise the current evidence base for health state utility values (HSUVs) in patients with chronic hepatitis C infection, generated using the EuroQol 5-dimensions (EQ-5D) questionnaire. METHODS MEDLINE, Embase, the Cochrane Library and EconLit were searched from database inception through 31 August 2017. Eligible studies reported HSUVs elicited using the EQ-5D questionnaire in adults with chronic hepatitis C infection. Study quality and risk of bias were assessed. RESULTS Of 1480 records identified, 26 studies were included. The most commonly defined health states described different stages of chronic hepatitis C infection and specific liver-related disease states, including METAVIR score, compensated and decompensated cirrhosis, hepatocellular carcinoma and liver transplantation. Patients with higher METAVIR scores tended to have lower EQ-5D scores compared to patients with lower METAVIR scores. Patients that achieved sustained virologic responses tended to have higher EQ-5D scores compared to those that did not. A meta-analysis conducted on three studies confirmed that patients with decompensated cirrhosis have significantly lower HSUVs than patients with compensated cirrhosis [mean difference - 0.11 (95% CI - 0.19 to - 0.04)], implying worse HRQoL. However, there was not sufficient evidence to compare how different treatments for chronic hepatitis C infection affect EQ-5D scores. CONCLUSIONS This study provides a summary of EQ-5D HSUVs for patients with chronic hepatitis C infection, and demonstrates that clinically important disease stages associated with treatment decisions are associated with differences in HRQoL.
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Affiliation(s)
| | - M Buti
- Hospital Universitario Valle Hebron, Barcelona, Spain.,Ciberehd del Instituto Carlos III, Madrid, Spain
| | - K Hanman
- Costello Medical Consulting Ltd, Cambridge, UK
| | - B Langford
- Costello Medical Consulting Ltd, Cambridge, UK
| | - M Wright
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L A Eddowes
- Costello Medical Consulting Ltd, Cambridge, UK
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Dobler CC, Morgan RL, Falck-Ytter Y, Montori VM, Murad MH. Assessing the validity of surrogate endpoints in the context of a controversy about the measurement of effectiveness of hepatitis C virus treatment. BMJ Evid Based Med 2018; 23:50-53. [PMID: 29595129 DOI: 10.1136/bmjebm-2017-110852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 01/27/2023]
Abstract
Surrogate endpoints are often used in clinical trials, as they allow for indirect measures of outcomes (eg, shorter trials with less participants). Improvements in surrogate endpoints (eg, reduction in low density lipoprotein cholesterol, normalisation of glycated haemoglobin) achieved with an intervention are, however, not always associated with improvements in patient-important outcomes. The common tendency in evidence-based medicine is to view results based on surrogate endpoints as less certain than results based on long term, final patient-important outcomes and rate them as 'lower quality evidence'. However, careful appraisal of the validity of a surrogate endpoint as a measure of the final, patient-important outcome is more useful than an automatic judgement. In this guide, we use a contemporary and currently highly debated example of the surrogate endpoint 'sustained viral response' (ie, viral eradication considered to represent successful treatment) in patients treated for chronic hepatitis C virus. We demonstrate how the validity of a surrogate endpoint can be critically appraised to assess the quality of the evidence (ie, the certainty in estimates) and the implications for decision-making.
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Affiliation(s)
- Claudia C Dobler
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yngve Falck-Ytter
- Division of Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - M Hassan Murad
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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11
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Falla AM, Hofstraat SHI, Duffell E, Hahné SJM, Tavoschi L, Veldhuijzen IK. Hepatitis B/C in the countries of the EU/EEA: a systematic review of the prevalence among at-risk groups. BMC Infect Dis 2018; 18:79. [PMID: 29433454 PMCID: PMC5809955 DOI: 10.1186/s12879-018-2988-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/31/2018] [Indexed: 12/22/2022] Open
Abstract
Background In 2016, the World Health Organisation set a goal to eliminate viral hepatitis by 2030. Robust epidemiological information underpins all efforts to achieve elimination and this systematic review provides estimates of HBsAg and anti-HCV prevalence in the European Union/European Economic Area (EU/EEA) among three at-risk populations: people in prison, men who have sex with men (MSM), and people who inject drugs (PWID). Methods Estimates of the prevalence among the three risk groups included in our study were derived from multiple sources. A systematic search of literature published during 2005–2015 was conducted without linguistic restrictions to identify studies among people in prison and HIV negative/HIV sero-status unknown MSM. National surveillance focal points were contacted to validate the search results. Studies were assessed for risk of bias and high quality estimates were pooled at country level. PWID data were extracted from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) repository. Results Despite gaps, we report 68 single study/pooled HBsAg/anti-HCV prevalence estimates covering 23/31 EU/EEA countries, 42 of which were of intermediate/high prevalence using the WHO endemicity threshold (of ≥2%). This includes 20 of the 23 estimates among PWID, 20 of the 28 high quality estimates among people in prison, and four of the 17 estimates among MSM. In general terms, the highest HBsAg prevalence was found among people in prison (range of 0.3% - 25.2%) followed by PWID (0.5% - 6.1%) and MSM (0.0% - 1.4%). The highest prevalence of anti-HCV was also found among people in prison (4.3% - 86.3%) and PWID (13.8% - 84.3%) followed by MSM (0.0% - 4.7%). Conclusions Our results suggest prioritisation of PWID and the prison population as the key populations for HBV/HCV screening and treatment given their dynamic interaction and high prevalence. The findings of this study do not seem to strongly support the continued classification of MSM as a high risk group for chronic hepatitis B infection. However, we still consider MSM a key population for targeted action given the emerging evidence of viral hepatitis transmission within this risk group together with the complex interaction of HBV/HCV and HIV. Electronic supplementary material The online version of this article (10.1186/s12879-018-2988-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abby May Falla
- Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands. .,Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Box 70032, 3000 LP, Rotterdam, The Netherlands.
| | - Sanne Henrietta Ina Hofstraat
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Postbus 1, 3720 BA, Bilthoven, the Netherlands
| | - Erika Duffell
- European Centre for Disease Prevention and Control, Granits väg 8, 171 65, Solna, Sweden
| | - Susan Josien Maria Hahné
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Postbus 1, 3720 BA, Bilthoven, the Netherlands
| | - Lara Tavoschi
- European Centre for Disease Prevention and Control, Granits väg 8, 171 65, Solna, Sweden
| | - Irene Karen Veldhuijzen
- Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands.,National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Postbus 1, 3720 BA, Bilthoven, the Netherlands
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12
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Aby E, Jimenez MA, Grotts JF, Agopian V, French SW, Busuttil RW, Saab S. Diminishing Use of Liver Biopsy among Liver Transplant Recipients for Hepatitis C. J Clin Transl Hepatol 2017; 5:197-202. [PMID: 28936400 PMCID: PMC5606965 DOI: 10.14218/jcth.2016.00073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/17/2017] [Accepted: 04/23/2017] [Indexed: 12/12/2022] Open
Abstract
Background and Aims: Hepatitis C virus (HCV) cirrhosis is the leading indication for liver transplantation in the United States and recurrent HCV following liver transplantation is a major cause of allograft loss and mortality. Liver biopsies are commonly used to identify recurrent HCV and determine the need for antiviral therapy. The introduction of direct-acting antiviral agents (DAAs) has changed the management of recurrent HCV infection. This study aimed to describe the role of liver biopsies in liver transplant recipients with HCV after the introduction of DAAs. Methods: A retrospective analysis was performed looking at the rate of liver biopsies post-liver transplantation for HCV. The analysis included 475 adult liver transplants for hepatitis C performed at the University of California, Los Angeles from January 1, 2006 to October 1, 2015. Patients were divided into two eras, pre- and post-introduction of DAAs on December 1, 2013. Results: In the era before the introduction of DAAs, the percentage of patients biopsied was significantly higher compared to the era after the introduction of DAAs (56.1% vs. 26.9%, p < 0.001). Conclusions: The introduction of DAAs has changed the management of liver biopsy following liver transplantation and the management of recurrent HCV. Given that DAAs are well tolerated and have high efficacy, liver biopsies are no longer routinely used to justify the use antiviral therapy following liver transplantation.
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Affiliation(s)
- Elizabeth Aby
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Melissa A. Jimenez
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Jonathan F. Grotts
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Vatche Agopian
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Samuel W. French
- Departments of Pathology at the University of California at Los Angeles, Los Angeles, California, USA
| | - Ronald W. Busuttil
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sammy Saab
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
- *Correspondence to: Sammy Saab, Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA. Tel: +1-310-206-6705, Fax: +1-310-206-4197, E-mail:
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13
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Jakobsen JC, Nielsen EE, Feinberg J, Katakam KK, Fobian K, Hauser G, Poropat G, Djurisic S, Weiss KH, Bjelakovic M, Bjelakovic G, Klingenberg SL, Liu JP, Nikolova D, Koretz RL, Gluud C. Direct-acting antivirals for chronic hepatitis C. Cochrane Database Syst Rev 2017; 9:CD012143. [PMID: 28922704 PMCID: PMC6484376 DOI: 10.1002/14651858.cd012143.pub3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Millions of people worldwide suffer from hepatitis C, which can lead to severe liver disease, liver cancer, and death. Direct-acting antivirals (DAAs), e.g. sofosbuvir, are relatively new and expensive interventions for chronic hepatitis C, and preliminary results suggest that DAAs may eradicate hepatitis C virus (HCV) from the blood (sustained virological response). Sustained virological response (SVR) is used by investigators and regulatory agencies as a surrogate outcome for morbidity and mortality, based solely on observational evidence. However, there have been no randomised trials that have validated that usage. OBJECTIVES To assess the benefits and harms of DAAs in people with chronic HCV. SEARCH METHODS We searched for all published and unpublished trials in The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, LILACS, and BIOSIS; the Chinese Biomedical Literature Database (CBM), China Network Knowledge Information (CNKI), the Chinese Science Journal Database (VIP), Google Scholar, The Turning Research into Practice (TRIP) Database, ClinicalTrials.gov, European Medicines Agency (EMA) (www.ema.europa.eu/ema/), WHO International Clinical Trials Registry Platform (www.who.int/ictrp), the Food and Drug Administration (FDA) (www.fda.gov), and pharmaceutical company sources for ongoing or unpublished trials. Searches were last run in October 2016. SELECTION CRITERIA Randomised clinical trials comparing DAAs versus no intervention or placebo, alone or with co-interventions, in adults with chronic HCV. We included trials irrespective of publication type, publication status, and language. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were hepatitis C-related morbidity, serious adverse events, and health-related quality of life. Our secondary outcomes were all-cause mortality, ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, hepatocellular carcinoma, non-serious adverse events (each reported separately), and SVR. We systematically assessed risks of bias, performed Trial Sequential Analysis, and followed an eight-step procedure to assess thresholds for statistical and clinical significance. We evaluated the overall quality of the evidence, using GRADE. MAIN RESULTS We included a total of 138 trials randomising a total of 25,232 participants. The trials were generally short-term trials and designed primarily to assess the effect of treatment on SVR. The trials evaluated 51 different DAAs. Of these, 128 trials employed matching placebo in the control group. All included trials were at high risk of bias. Eighty-four trials involved DAAs on the market or under development (13,466 participants). Fifty-seven trials administered DAAs that were discontinued or withdrawn from the market. Study populations were treatment-naive in 95 trials, had been exposed to treatment in 17 trials, and comprised both treatment-naive and treatment-experienced individuals in 24 trials. The HCV genotypes were genotype 1 (119 trials), genotype 2 (eight trials), genotype 3 (six trials), genotype 4 (nine trials), and genotype 6 (one trial). We identified two ongoing trials.We could not reliably determine the effect of DAAs on the market or under development on our primary outcome of hepatitis C-related morbidity or all-cause mortality. There were no data on hepatitis C-related morbidity and only limited data on mortality from 11 trials (DAA 15/2377 (0.63%) versus control 1/617 (0.16%); OR 3.72, 95% CI 0.53 to 26.18, very low-quality evidence). We did not perform Trial Sequential Analysis on this outcome.There is very low quality evidence that DAAs on the market or under development do not influence serious adverse events (DAA 5.2% versus control 5.6%; OR 0.93, 95% CI 0.75 to 1.15 , 15,817 participants, 43 trials). The Trial Sequential Analysis showed that there was sufficient information to rule out that DAAs reduce the relative risk of a serious adverse event by 20% when compared with placebo. The only DAA that showed a lower risk of serious adverse events when meta-analysed separately was simeprevir (OR 0.62, 95% CI 0.45 to 0.86). However, Trial Sequential Analysis showed that there was not enough information to confirm or reject a relative risk reduction of 20%, and when one trial with an extreme result was excluded, the meta-analysis result showed no evidence of a difference.DAAs on the market or under development may reduce the risk of no SVR from 54.1% in untreated people to 23.8% in people treated with DAA (RR 0.44, 95% CI 0.37 to 0.52, 6886 participants, 32 trials, low quality evidence). Trial Sequential Analysis confirmed this meta-analysis result.Only 1/84 trials on the market or under development assessed the effects of DAAs on health-related quality of life (SF-36 mental score and SF-36 physical score).There was insufficient evidence from trials on withdrawn or discontinued DAAs to determine their effect on hepatitis C-related morbidity and all-cause mortality (OR 0.64, 95% CI 0.23 to 1.79; 5 trials, very low-quality evidence). However, these DAAs seemed to increase the risk of serious adverse events (OR 1.45, 95% CI 1.22 to 1.73; 29 trials, very low-quality evidence). Trial Sequential Analysis confirmed this meta-analysis result.None of the 138 trials provided useful data to assess the effects of DAAs on the remaining secondary outcomes (ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, and hepatocellular carcinoma). AUTHORS' CONCLUSIONS The evidence for our main outcomes of interest come from short-term trials, and we are unable to determine the effect of long-term treatment with DAAs. The rates of hepatitis C morbidity and mortality observed in the trials are relatively low and we are uncertain as to how DAAs affect this outcome. Overall, there is very low quality evidence that DAAs on the market or under development do not influence serious adverse events. There is insufficient evidence to judge if DAAs have beneficial or harmful effects on other clinical outcomes for chronic HCV. Simeprevir may have beneficial effects on risk of serious adverse event. In all remaining analyses, we could neither confirm nor reject that DAAs had any clinical effects. DAAs may reduce the number of people with detectable virus in their blood, but we do not have sufficient evidence from randomised trials that enables us to understand how SVR affects long-term clinical outcomes. SVR is still an outcome that needs proper validation in randomised clinical trials.
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Affiliation(s)
| | - Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Joshua Feinberg
- Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812Blegdamsvej 9CopenhagenDenmark2100
| | - Kiran Kumar Katakam
- Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812Blegdamsvej 9CopenhagenDenmark2100
| | - Kristina Fobian
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Goran Hauser
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Goran Poropat
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Snezana Djurisic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Karl Heinz Weiss
- Heidelberg University HospitalInternal Medicine IV: Gastroenterology, Infectious Diseases, ToxicologyIm Neuenheimer Feld 410HeidelbergGermanyD‐69120
| | - Milica Bjelakovic
- University of NisMedical FacultyBoulevard Dr Zorana Djindjica 81NisSerbia18000
| | - Goran Bjelakovic
- Medical Faculty, University of NisDepartment of Internal MedicineZorana Djindjica 81NisSerbia18000
| | - Sarah Louise Klingenberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Jian Ping Liu
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department
7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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14
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Jakobsen JC, Nielsen EE, Feinberg J, Katakam KK, Fobian K, Hauser G, Poropat G, Djurisic S, Weiss KH, Bjelakovic M, Bjelakovic G, Klingenberg SL, Liu JP, Nikolova D, Koretz RL, Gluud C. Direct-acting antivirals for chronic hepatitis C. Cochrane Database Syst Rev 2017; 6:CD012143. [PMID: 28585310 PMCID: PMC6484383 DOI: 10.1002/14651858.cd012143.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Millions of people worldwide suffer from hepatitis C, which can lead to severe liver disease, liver cancer, and death. Direct-acting antivirals (DAAs) are relatively new and expensive interventions for chronic hepatitis C, and preliminary results suggest that DAAs may eradicate hepatitis C virus (HCV) from the blood (sustained virological response). However, it is still questionable if eradication of hepatitis C virus in the blood eliminates hepatitis C in the body, and improves survival and leads to fewer complications. OBJECTIVES To assess the benefits and harms of DAAs in people with chronic HCV. SEARCH METHODS We searched for all published and unpublished trials in The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, LILACS, and BIOSIS; the Chinese Biomedical Literature Database (CBM), China Network Knowledge Information (CNKI), the Chinese Science Journal Database (VIP), Google Scholar, The Turning Research into Practice (TRIP) Database, ClinicalTrials.gov, European Medicines Agency (EMA) (www.ema.europa.eu/ema/), WHO International Clinical Trials Registry Platform (www.who.int/ictrp), the Food and Drug Administration (FDA) (www.fda.gov), and pharmaceutical company sources for ongoing or unpublished trials. Searches were last run in October 2016. SELECTION CRITERIA Randomised clinical trials comparing DAAs versus no intervention or placebo, alone or with co-interventions, in adults with chronic HCV. We included trials irrespective of publication type, publication status, and language. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were hepatitis C-related morbidity, serious adverse events, and quality of life. Our secondary outcomes were all-cause mortality, ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, hepatocellular carcinoma, non-serious adverse events (each reported separately), and sustained virological response. We systematically assessed risks of bias, performed Trial Sequential Analysis, and followed an eight-step procedure to assess thresholds for statistical and clinical significance. The overall quality of the evidence was evaluated using GRADE. MAIN RESULTS We included a total of 138 trials randomising a total of 25,232 participants. The 138 trials assessed the effects of 51 different DAAs. Of these, 128 trials employed matching placebo in the control group. All included trials were at high risk of bias. Eighty-four trials involved DAAs on the market or under development (13,466 participants). Fifty-seven trials administered withdrawn or discontinued DAAs. Trial participants were treatment-naive (95 trials), treatment-experienced (17 trials), or both treatment-naive and treatment-experienced (24 trials). The HCV genotypes were genotype 1 (119 trials), genotype 2 (eight trials), genotype 3 (six trials), genotype 4 (nine trials), and genotype 6 (one trial). We identified two ongoing trials.Meta-analysis of the effects of all DAAs on the market or under development showed no evidence of a difference when assessing hepatitis C-related morbidity or all-cause mortality (OR 3.72, 95% CI 0.53 to 26.18, P = 0.19, I² = 0%, 2,996 participants, 11 trials, very low-quality evidence). As there were no data on hepatitis C-related morbidity and very few data on mortality (DAA 15/2377 (0.63%) versus control 1/617 (0.16%)), it was not possible to perform Trial Sequential Analysis on hepatitis C-related morbidity or all-cause mortality.Meta-analysis of all DAAs on the market or under development showed no evidence of a difference when assessing serious adverse events (OR 0.93, 95% CI 0.75 to 1.15, P = 0.52, I² = 0%, 15,817 participants, 43 trials, very low-quality evidence). The Trial Sequential Analysis showed that the cumulative Z-score crossed the trial sequential boundary for futility, showing that there was sufficient information to rule out that DAAs compared with placebo reduced the relative risk of a serious adverse event by 20%. The only DAA that showed a significant difference on risk of serious adverse events when meta-analysed separately was simeprevir (OR 0.62, 95% CI 0.45 to 0.86). However, Trial Sequential Analysis showed that there was not enough information to confirm or reject a relative risk reduction of 20%, and when one trial with an extreme result was excluded, then the meta-analysis result showed no evidence of a difference.DAAs on the market or under development seemed to reduce the risk of no sustained virological response (RR 0.44, 95% CI 0.37 to 0.52, P < 0.00001, I² = 77%, 6886 participants, 32 trials, very low-quality evidence) and Trial Sequential Analysis confirmed this meta-analysis result.Only 1/84 trials on the market or under development assessed the effects of DAAs on health-related quality of life (SF-36 mental score and SF-36 physical score).Withdrawn or discontinued DAAs had no evidence of a difference when assessing hepatitis C-related morbidity and all-cause mortality (OR 0.64, 95% CI 0.23 to 1.79, P = 0.40, I² = 0%; 5 trials, very low-quality evidence). However, withdrawn DAAs seemed to increase the risk of serious adverse events (OR 1.45, 95% CI 1.22 to 1.73, P = 0.001, I² = 0%, 29 trials, very low-quality evidence), and Trial Sequential Analysis confirmed this meta-analysis result.Most of all outcome results were short-term results; therefore, we could neither confirm nor reject any long-term effects of DAAs. None of the 138 trials provided useful data to assess the effects of DAAs on the remaining secondary outcomes (ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, and hepatocellular carcinoma). AUTHORS' CONCLUSIONS Overall, DAAs on the market or under development do not seem to have any effects on risk of serious adverse events. Simeprevir may have beneficial effects on risk of serious adverse event. In all remaining analyses, we could neither confirm nor reject that DAAs had any clinical effects. DAAs seemed to reduce the risk of no sustained virological response. The clinical relevance of the effects of DAAs on no sustained virological response is questionable, as it is a non-validated surrogate outcome. All trials and outcome results were at high risk of bias, so our results presumably overestimate benefit and underestimate harm. The quality of the evidence was very low.
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Affiliation(s)
| | - Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Joshua Feinberg
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Kiran Kumar Katakam
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalBlegdamsvej 9CopenhagenDenmark2100
| | - Kristina Fobian
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Goran Hauser
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Goran Poropat
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Snezana Djurisic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalBlegdamsvej 9CopenhagenDenmark2100
| | - Karl Heinz Weiss
- Heidelberg University HospitalInternal Medicine IV: Gastroenterology, Infectious Diseases, ToxicologyIm Neuenheimer Feld 410HeidelbergGermanyD‐69120
| | - Milica Bjelakovic
- University of NisMedical FacultyBoulevard Dr Zorana Djindjica 81NisSerbia18000
| | - Goran Bjelakovic
- Medical Faculty, University of NisDepartment of Internal MedicineZorana Djindjica 81NisSerbia18000
| | - Sarah Louise Klingenberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Jian Ping Liu
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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Than NN, Ghazanfar A, Hodson J, Tehami N, Coldham C, Mergental H, Manas D, Shah T, Newsome PN, Reeves H, Shetty S. Comparing clinical presentations, treatments and outcomes of hepatocellular carcinoma due to hepatitis C and non-alcoholic fatty liver disease. QJM 2017; 110:73-81. [PMID: 27634970 PMCID: PMC5444673 DOI: 10.1093/qjmed/hcw151] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is increasing in incidence in the UK and globally. Liver cirrhosis is the common cause for developing HCC. The common reasons for liver cirrhosis are viral hepatitis C (HCV), viral hepatitis B and alcohol. However, HCC caused by non-alcoholic fatty liver disease (NAFLD)-cirrhosis is now increasingly as a result of rising worldwide obesity. AIM : To compare the clinical presentation, treatment options and outcomes of HCC due to HCV and NAFLD patients. METHODS Data were collected from two liver transplant centres in the UK (Birmingham and Newcastle upon Tyne) between 2000 and 2014. We compared 275 patients with HCV-related HCC against 212 patients with NAFLD- related HCC. RESULTS Patients in the NAFLD group were found to be significantly older ( P < 0.001) and more likely to be Caucasian ( P < 0.001). They had lower rates of cirrhosis ( P < 0.001) than those in HCV-HCC group. The NAFLD group presented with significantly larger tumours ( P = 0.009), whilst HCV patients had a higher alpha fetoprotein ( P = 0.018). NAFLD patients were more commonly treated with TACE ( P = 0.005) than the HCV patients, whilst the HCV group were significantly more likely to be transplanted ( P < 0.001). In patients selected for liver transplantation, 5-year survival rates in NAFLD were not significantly different from HCV-HCC (44 and 56% respectively, P = 0.102). CONCLUSION In this study, NAFLD patients presented with larger tumours that were less likely to be amenable to curative therapy, as compared with HCV patients. Despite this disadvantage, patients with NAFLD had similar overall survival compared to patients with HCV.
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Affiliation(s)
- Nwe Ni Than
- From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - Anwar Ghazanfar
- Liver Unit, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - James Hodson
- From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK
| | - Nadeem Tehami
- From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - Chris Coldham
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - Hynek Mergental
- From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - Derek Manas
- Liver Unit, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Tahir Shah
- From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK
| | - Philip N. Newsome
- From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
| | - Helen Reeves
- Liver Unit, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Shishir Shetty
- From the Liver Unit, University Hospitals Birmingham NHS Trust, Birmingham, Edgbaston, UK
- National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
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16
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Alavian SM, Hajarizadeh B, Bagheri Lankarani K, Sharafi H, Ebrahimi Daryani N, Merat S, Mohraz M, Mardani M, Fattahi MR, Poustchi H, Nikbin M, Nabavi M, Adibi P, Ziaee M, Behnava B, Rezaee-Zavareh MS, Colombo M, Massoumi H, Bizri AR, Eghtesad B, Amiri M, Namvar A, Hesamizadeh K, Malekzadeh R. Recommendations for the Clinical Management of Hepatitis C in Iran: A Consensus-Based National Guideline. HEPATITIS MONTHLY 2016; 16:e40959. [PMID: 27799966 PMCID: PMC5075356 DOI: 10.5812/hepatmon.guideline] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 07/31/2016] [Indexed: 02/07/2023]
Abstract
CONTEXT Hepatitis C virus (HCV) infection is a major public health issue worldwide, including Iran. The new direct-acting antiviral agents (DAAs) with high efficacy have changed the landscape of HCV treatment. This guideline provides updated recommendations for clinical management of HCV infection in Iran. EVIDENCE ACQUISITION The recommendations of this guideline are based on international and national scientific evidences and consensus-based expert opinion. Scientific evidences were collected through a systematic review of studies that evaluated efficacy and safety of DAA regimens, using PubMed, Scopus and Web of Science. Expert opinion was based on the consensus of Iran Hepatitis Scientific Board (IHSB) in the 3rd national consensus on management of Hepatitis C in Iran, held on 22nd of July 2016. RESULTS Pegylated Interferon alpha (PegIFN), Ribavirin (RBV), Sofosbuvir (SOF), Ledipasvir (LDV) and Daclatasvir (DCV) are currently available in Iran. Pre-treatment assessments include HCV RNA level, HCV genotype and resistance testing, assessment of liver fibrosis, and underlying diseases. In HCV genotype 1 and 4, DCV/SOF and LDV/SOF are recommended. In HCV genotype 2, SOF plus RBV and in HCV genotype 3, DCV/SOF is recommended. Additional care for underlying diseases should be considered. CONCLUSIONS Affordable new HCV treatment regimens are available in Iran, providing an opportunity for HCV elimination. Recommendations provided in this current national guideline can facilitate evidence-based management of HCV infection.
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Affiliation(s)
- Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
- Corresponding Author: Seyed Moayed Alavian, Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-2181264070, E-mail:
| | - Behzad Hajarizadeh
- Viral Hepatitis Clinical Research Program, The Kirby Institute, The University of New South Wales (UNSW Australia), Sydney, Australia
| | | | - Heidar Sharafi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | | | - Shahin Merat
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Masoud Mardani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohamad Reza Fattahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mehri Nikbin
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | - Mahmood Nabavi
- Department of Infectious Diseases and Tropical Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Peyman Adibi
- Department of Gastroenterology and Hepatology, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Masood Ziaee
- Hepatitis Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
| | - Bita Behnava
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | - Mohammad Saeid Rezaee-Zavareh
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
- Student’s Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Massimo Colombo
- Department of Medicine, Gastroenterology Division 1, AM and A Migliavacca Center for the Study of Liver Disease, Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Hatef Massoumi
- New York Associates in Gastroenterology, Bronx, New York, USA
| | - Abdul Rahman Bizri
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Majid Amiri
- Gastroenterology and Hepatology Department, Gouin Hospital, Clichy, France
| | - Ali Namvar
- Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, IR Iran
| | - Khashayar Hesamizadeh
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases (MELD) Center, Tehran, IR Iran
| | - Reza Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
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Ogbuagu O, Friedland G, Bruce RD. Drug interactions between buprenorphine, methadone and hepatitis C therapeutics. Expert Opin Drug Metab Toxicol 2016; 12:721-31. [DOI: 10.1080/17425255.2016.1183644] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - R. Douglas Bruce
- Yale University School of Medicine, New Haven, CT, USA
- Department of Medicine, Cornell Scott-Hill Health Center, New Haven, CT, USA
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18
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Jakobsen JC, Nielsen EE, Feinberg J, Fobian K, Katakam KK, Hauser G, Poropat G, Djurisic S, Weiss KH, Bjelakovic M, Bjelakovic G, Klingenberg SL, Liu JP, Nikolova D, Koretz RL, Gluud C. Direct-acting antivirals for chronic hepatitis C. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Udina M, Navinés R, Egmond E, Oriolo G, Langohr K, Gimenez D, Valdés M, Gómez-Gil E, Grande I, Gratacós M, Kapczinski F, Artigas F, Vieta E, Solà R, Martín-Santos R. Glucocorticoid Receptors, Brain-Derived Neurotrophic Factor, Serotonin and Dopamine Neurotransmission are Associated with Interferon-Induced Depression. Int J Neuropsychopharmacol 2016; 19:pyv135. [PMID: 26721949 PMCID: PMC4851270 DOI: 10.1093/ijnp/pyv135] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/24/2015] [Accepted: 12/11/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The role of inflammation in mood disorders has received increased attention. There is substantial evidence that cytokine therapies, such as interferon alpha (IFN-alpha), can induce depressive symptoms. Indeed, proinflammatory cytokines change brain function in several ways, such as altering neurotransmitters, the glucocorticoid axis, and apoptotic mechanisms. This study aimed to evaluate the impact on mood of initiating IFN-alpha and ribavirin treatment in a cohort of patients with chronic hepatitis C. We investigated clinical, personality, and functional genetic variants associated with cytokine-induced depression. METHODS We recruited 344 Caucasian outpatients with chronic hepatitis C, initiating IFN-alpha and ribavirin therapy. All patients were euthymic at baseline according to DSM-IV-R criteria. Patients were assessed at baseline and 4, 12, 24, and 48 weeks after treatment initiation using the Patient Health Questionnaire (PHQ), the Hospital Anxiety and Depression Scale (HADS), and the Temperament and Character Inventory (TCI). We genotyped several functional polymorphisms of interleukin-28 (IL28B), indoleamine 2,3-dioxygenase (IDO-1), serotonin receptor-1A (HTR1A), catechol-O-methyl transferase (COMT), glucocorticoid receptors (GCR1 and GCR2), brain-derived neurotrophic factor (BDNF), and FK506 binding protein 5 (FKBP5) genes. A survival analysis was performed, and the Cox proportional hazards model was used for the multivariate analysis. RESULTS The cumulative incidence of depression was 0.35 at week 24 and 0.46 at week 48. The genotypic distributions were in Hardy-Weinberg equilibrium. Older age (p = 0.018, hazard ratio [HR] per 5 years = 1.21), presence of depression history (p = 0.0001, HR = 2.38), and subthreshold depressive symptoms at baseline (p = 0.005, HR = 1.13) increased the risk of IFN-induced depression. So too did TCI personality traits, with high scores on fatigability (p = 0.0037, HR = 1.17), impulsiveness (p = 0.0200 HR = 1.14), disorderliness (p = 0.0339, HR = 1.11), and low scores on extravagance (p = 0.0040, HR = 0.85). An interaction between HTR1A and COMT genes was found. Patients carrying the G allele of HTR1A plus the Met substitution of the COMT polymorphism had a greater risk for depression during antiviral treatment (HR = 3.83) than patients with the CC (HTR1A) and Met allele (COMT) genotypes. Patients carrying the HTR1A CC genotype and the COMT Val/Val genotype (HR = 3.25) had a higher risk of depression than patients with the G allele (HTR1A) and the Val/Val genotype. Moreover, functional variants of the GCR1 (GG genotype: p = 0.0436, HR = 1.88) and BDNF genes (Val/Val genotype: p = 0.0453, HR = 0.55) were associated with depression. CONCLUSIONS The results of the study support the theory that IFN-induced depression is associated with a complex pathophysiological background, including serotonergic and dopaminergic neurotransmission as well as glucocorticoid and neurotrophic factors. These findings may help to improve the management of patients on antiviral treatment and broaden our understanding of the pathogenesis of mood disorders.
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MESH Headings
- Adult
- Antiviral Agents/therapeutic use
- Brain-Derived Neurotrophic Factor/genetics
- Catechol O-Methyltransferase/genetics
- Depression/chemically induced
- Depression/epidemiology
- Depression/genetics
- Depression/immunology
- Female
- Genetic Predisposition to Disease
- Hepatitis C, Chronic/drug therapy
- Hepatitis C, Chronic/epidemiology
- Hepatitis C, Chronic/genetics
- Hepatitis C, Chronic/psychology
- Humans
- Incidence
- Indoleamine-Pyrrole 2,3,-Dioxygenase/genetics
- Interferon-alpha/adverse effects
- Interferon-alpha/therapeutic use
- Interferons
- Interleukins/genetics
- Male
- Middle Aged
- Polymorphism, Single Nucleotide
- Prospective Studies
- Receptor, Serotonin, 5-HT1A/genetics
- Receptors, Glucocorticoid/genetics
- Ribavirin/therapeutic use
- Tacrolimus Binding Proteins/genetics
- Treatment Outcome
- White People/genetics
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Affiliation(s)
- M Udina
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - R Navinés
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - E Egmond
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - G Oriolo
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - K Langohr
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - D Gimenez
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - M Valdés
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - E Gómez-Gil
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - I Grande
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - M Gratacós
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - F Kapczinski
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - F Artigas
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - E Vieta
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - R Solà
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
| | - R Martín-Santos
- Department of Psychiatry, Hospital Clínic, Institut d'Investigacions Biomèdiques de Barcelona (IDIBAPS), Spain (Drs Udina, Navinés, Egmond, Oriolo, Valdés, Gómez-Gil, Grande, Vieta, and Martín-Santos); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain (Drs Navinés, Grande, Artigas, Vieta, and Martín-Santos); Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain (Drs Oriolo, Valdés, Vieta, and Martín-Santos); Liver Section, Parc de Salut Mar, UAB, Barcelona, Spain (Drs Navinés, Gimenez, and Solà); Department of Clinical and Health Psychology, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain (Egmond); Departament d'Estadística, Investigació Operativa, Universitat Politècnica de Catalunya and Research programme in Neurosciences, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (Dr Langohr); Center of Genomic Regulation, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain (Dr Gratacós); National Institute for Translational Medicine, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Kapczinski); Department of Neurochemistry and Neuropharmacology, Institute d'Investigacions Biomèdiques de Barcelona (IBB-CSIC-IDIBAPS), Spain (Dr Artigas)
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Abstract
Continued discovery and development of new antiviral medications are paramount for global human health, particularly as new pathogens emerge and old ones evolve to evade current therapeutic agents. Great success has been achieved in developing effective therapies to suppress human immunodeficiency virus (HIV) and hepatitis B virus (HBV); however, the therapies are not curative and therefore current efforts in HIV and HBV drug discovery are directed toward longer-acting therapies and/or developing new mechanisms of action that could potentially lead to cure, or eradication, of the virus. Recently, exciting early clinical data have been reported for novel antivirals targeting respiratory syncytial virus (RSV) and influenza (flu). Preclinical data suggest that these new approaches may be effective in treating high-risk patients afflicted with serious RSV or flu infections. In this review, we highlight new directions in antiviral approaches for HIV, HBV, and acute respiratory virus infections.
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Affiliation(s)
- Wade Blair
- Department of Antiviral Research, Merck Research Laboratories, West Point, Pennsylvania, 19438, USA
| | - Christopher Cox
- Department of Discovery Chemistry, Merck Research Laboratories, West Point, Pennsylvania, 19438, USA
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Rezaee Zavareh MS, Alavian SM. Occult Hepatitis C Infection Should Be More Noticed With New Treatment Strategies. HEPATITIS MONTHLY 2015; 15:e33462. [PMID: 26834794 PMCID: PMC4717287 DOI: 10.5812/hepatmon.33462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/04/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Mohammad Saeid Rezaee Zavareh
- Students’ Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Diseases Center, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Middle East Liver Diseases Center, Tehran, IR Iran
- Baqiyatallah Research Center for Gasteroenterology and Liver Disease (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Seyed Moayed Alavian, Middle East Liver Diseases Center, Tehran, IR Iran. Tel: +98-2188945186, Fax: +98-2188945188, E-mail:
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