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Jolly G, Razakamanantsoa L, Fresnel E, Gharsallaoui Z, Cuvelier A, Patout M. Defining successful non-invasive ventilation initiation: Data from a real-life cohort. Respirology 2021; 26:1067-1075. [PMID: 34312942 DOI: 10.1111/resp.14118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/31/2021] [Accepted: 07/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE When home non-invasive ventilation (NIV) is initiated, five goals need to be achieved: a daily use >4 h/day, an improvement in gas exchange, health-related quality of life (HRQL) and sleep quality without side effects. Our aim was to assess how frequently these five goals were reached and the factors predictive of achievement. METHODS We conducted a monocentric cohort study that included patients electively established on home NIV over 2 years. HRQL was assessed at baseline and follow-up by the Severe Respiratory Insufficiency questionnaire. Adequate initiation was defined as the achievement of at least three of five goals and successful initiation as the achievement of all. RESULTS Two-hundred and fifty patients were included at baseline. NIV was initiated for: obesity hypoventilation syndrome (n = 95; 38%), neuromuscular disease (n = 70; 28%), chronic obstructive pulmonary disease (n = 66; 26%) and chest wall disease (n = 19; 8%). At follow-up, measures of all five goals were available in 141 (56%) patients. NIV initiation was adequate for 96 (68%) patients and successful for 12 (9%) patients. In multivariate analysis, a tidal volume ≥ 7.8 ml/kg of ideal body weight was associated with an increased likelihood of adequate NIV initiation (hazard ratio: 5.765 [95% CI:1.824-18.223], p = 0.006]. Improvement in daytime partial arterial carbon dioxide pressure (PaCO2 ) was not correlated to improvement in HRQL or sleep quality. Severe to very severe NIV-related side effects occurred in 114 (47%) patients and were associated with higher daytime PaCO2 (6.35 ± 1.08 vs. 5.92 ± 0.79 kPa, p < 0.001). CONCLUSION Successful home NIV initiation is rarely achieved in real life. HRQL and NIV tolerance should be assessed to improve patient-centred outcomes.
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Affiliation(s)
- Grégoire Jolly
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France
| | - Léa Razakamanantsoa
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIRouen, Rouen, France
| | | | - Zouhaier Gharsallaoui
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France
| | - Antoine Cuvelier
- Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Rouen University Hospital, Rouen University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIRouen, Rouen, France
| | - Maxime Patout
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIRouen, Rouen, France.,Service des Pathologies du Sommeil (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,URMS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
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2
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Tacke F, Boeker KHW, Klinker H, Heyne R, Buggisch P, Pathil A, Wiegand J, Cornberg M, Lange C, Berg T, Zeuzem S, Mauss S. Baseline risk factors determine lack of biochemical response after SVR in chronic hepatitis C patients treated with DAAs. Liver Int 2020; 40:539-548. [PMID: 31241820 DOI: 10.1111/liv.14186] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Liver function tests (alanine aminotransferase, ALT; gamma-glutamyltransferase, GGT) not always normalize after elimination of hepatitis C virus (HCV) by direct acting antivirals (DAAs), possibly indicating concomitant non-viral liver diseases. We analysed factors determining the biochemical response (normalized ALT/GGT) of DAA therapy in a large real-world cohort. METHOD The German Hepatitis C-Registry is a national multicenter registry study. Normal ALT was defined ≤35 U/L (female) and ≤50 U/L (male) or, according to AASLD, ≤19 U/L (female) and ≤30 U/L (male), normal GGT ≤40 U/L (female) and ≤60 U/L (male). RESULTS At baseline, ALT was elevated in 3705/4946 (74.9%), ALT (AASLD) in 4669/4946 (94.4%) and GGT in 3018/4906 (61.5%). In this study, 97% of patients achieved SVR12. At week 12 after end of therapy, ALT was elevated in 451/4946 (9.1%), ALT according to AASLD in 1906/4946 (38.5%) and GGT in 863/4879 (17.7%). Persistently elevated ALT after DAA therapy was independently associated with high body mass index (BMI), age <70 years, liver cirrhosis, diabetes, alcohol consumption and not achieving SVR12. Using the stricter AASLD criteria, opioid substitution and male sex were additional predictors. Higher GGT at week 12 was associated with high BMI, age >70 years, liver cirrhosis, diabetes, alcohol consumption, opioid substitution and non-SVR. Importantly, persistently elevated liver tests after treatment, particularly GGT, were associated with hepatic decompensation and mortality during 4-years follow-up. CONCLUSION Risk factors at baseline (obesity, diabetes, liver cirrhosis, alcohol consumption) are independently associated with persistently elevated liver function tests after SVR, indicating that these patients warrant further hepatological follow-up. CLINICAL TRIAL REGISTRATION German Clinical Trials Register (DRKS; ID DRKS00009717).
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Affiliation(s)
- Frank Tacke
- Department of Medicine III, University Hospital Aachen, Aachen, Germany.,Department of Hepatology/Gastroenterology, Charité University Medical Center, Berlin, Germany
| | | | | | | | - Peter Buggisch
- ifi-Institute for Interdisciplinary Medicine, Hamburg, Germany
| | - Anita Pathil
- Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Christian Lange
- Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Thomas Berg
- University Hospital Leipzig, Leipzig, Germany
| | - Stefan Zeuzem
- University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
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3
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Liefferinckx C, Verstockt B, Gils A, Noman M, Van Kemseke C, Macken E, De Vos M, Van Moerkercke W, Rahier JF, Bossuyt P, Dutré J, Humblet E, Staessen D, Peeters H, Van Hootegem P, Louis E, Franchimont D, Baert F, Vermeire S. Long-term Clinical Effectiveness of Ustekinumab in Patients with Crohn's Disease Who Failed Biologic Therapies: A National Cohort Study. J Crohns Colitis 2019; 13:1401-1409. [PMID: 30989232 DOI: 10.1093/ecco-jcc/jjz080] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ustekinumab [UST] was recently approved in Europe for the treatment of moderate to severe Crohn's disease [CD]. Long-term real-world data are currently scarce for CD patients previously exposed to several biologics. METHODS This is an observational, national, retrospective multicentre study. Patients received intravenous UST ~6 mg/kg at baseline, with 90 mg subcutaneously thereafter every 8 weeks. Response and remission rates were assessed at Weeks 8, 16, and 52. RESULTS Data from 152 patients were analysed. All patients were exposed to at least one anti-TNFα agent, with 69.7% were exposed to even two anti-TNFα and vedolizumab. After 1 year, 42.1% and 25.7% of patients had experienced clinical response and clinical remission, respectively, and 38.8% and 24.3% had achieved steroid-free clinical response and remission, respectively; 38.8% of patients discontinued therapy during the 12 months of follow-up. Colonic location was predictive of clinical response at 1 year, and low body mass index [BMI] at baseline was a negative predictor of clinical remission. Resolution of arthralgia was associated with clinical response over time. De novo arthralgia was reported by 17.9% of patients at Week 8 and 13.5% of patients at Week 52. No impact of UST on arthralgia was observed in patients with concomitant ankylosing spondylitis [n = 17]. Others adverse events were reported in 7.2% of patients. CONCLUSIONS This real-world cohort study confirms the effectiveness of UST in CD patients previously exposed to several biologics. Ustekinumab was well tolerated with respect to adverse events. PODCAST This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
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Affiliation(s)
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium, KU Leuven, Belgium
| | - Ann Gils
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Maja Noman
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium, KU Leuven, Belgium
| | - Catherine Van Kemseke
- Department of Gastroenterology, Centre Hospitalier Universitaire Sart-Tilman, ULG, Liège, Belgium
| | - Elisabeth Macken
- Department of Gastroenterology, Universitair Ziekenhuis Antwerpen, UZA, Antwerpen, Belgium
| | - Martine De Vos
- Department of Gastroenterology, Universitair Ziekenhuis Gent, Gent, Belgium
| | | | - Jean-Francois Rahier
- Department of Gastroenterology, Centre Hospitalier Universitaire Mont-Godinne, UCL, Yvoir, Belgium
| | - Peter Bossuyt
- Department of Gastroenterology, Imeldaziekenhuis, Bonheiden, Belgium
| | - Joris Dutré
- Department of Gastroenterology, Ziekenhuis Netwerk Antwerpen, Antwerpen, Belgium
| | - Evelien Humblet
- Department of Gastroenterology, Ziekenhuis Oost-Limburg - Campus Sint-Jan, Genk, Belgium
| | - Dirk Staessen
- Department of Gastroenterology, GZA Sint-Vincentius ziekenhuis, Antwerpen, Belgium
| | - Harald Peeters
- Department of Gastroenterology, Algemeen Ziekenhuis Sint-Lucas, Gent, Belgium
| | | | - Edouard Louis
- Department of Gastroenterology, Centre Hospitalier Universitaire Sart-Tilman, ULG, Liège, Belgium
| | - Denis Franchimont
- Department of Gastroenterology, Hôpital Erasme, ULB, Brussels, Belgium
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare-Menen, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Leuven, Belgium, KU Leuven, Belgium
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Jacot W, Heudel PE, Fraisse J, Gourgou S, Guiu S, Dalenc F, Pistilli B, Campone M, Levy C, Debled M, Leheurteur M, Chaix M, Lefeuvre C, Goncalves A, Uwer L, Ferrero JM, Eymard JC, Petit T, Mouret-Reynier MA, Courtinard C, Cottu P, Robain M, Mailliez A. Real-life activity of eribulin mesylate among metastatic breast cancer patients in the multicenter national observational ESME program. Int J Cancer 2019; 145:3359-3369. [PMID: 31087564 DOI: 10.1002/ijc.32402] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 01/09/2023]
Abstract
Eribulin mesylate (EM) was recently approved for metastatic breast cancer (MBC) chemotherapy (CT) in late lines by the FDA, with debated results in second line. We evaluated outcomes in breast cancer patients receiving EM as second, third and fourth line in a national real-life cohort of 16,703 consecutive MBC patients initiating their first metastatic therapeutic line between 2008 and 2014. Primary and secondary objectives were overall survival (OS) and progression-free survival (PFS). An imbalance was seen for HER2+ tumors and concomitant anti-HER2 targeted therapies use, we thus performed a subanalysis in HER2- patients. PFS and OS were significantly better in EM patients in third and fourth lines, compared to "Other chemotherapies" patients (PFS: 4.14 vs. 3.02 months, p = 0.0010; 3.61 vs. 2.53 months, p = 0.0102, third and fourth-line; OS: 11.27 vs. 7.65 months, p = 0.0001; 10.91 vs. 5.95 months, p < 0.0001, third and fourth-line). No significant difference was reported in second-line (PFS: 5.06 vs. 4.14 months, p = 0.1171; OS: 13.99 vs. 11.66 months, p = 0.151). Among HER2- patients, a significant difference was seen for all lines, including 2nd-line (PFS: 4.57 vs. 3.91 months, p = 0.0379; OS: 14.98 vs. 10.51 months, p = 0.0113). In this large real-world database, HER2-negative MBC patients receiving EM in second or later CT line presented significantly better PFS and OS. This difference disappeared in second line in the overall population, probably because of the imbalance in HER2-targeted treatments use. Our results mirror those of the published randomized trials. The effect of anti-HER2 therapies addition in this setting still needs to be defined.
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Affiliation(s)
- William Jacot
- Institut du Cancer de Montpellier (ICM) Val d'Aurelle, Montpellier University, Montpellier, France.,IRCM INSERM U1194, Montpellier, France
| | | | - Julien Fraisse
- Institut du Cancer de Montpellier (ICM) Val d'Aurelle, Montpellier University, Montpellier, France
| | - Sophie Gourgou
- Institut du Cancer de Montpellier (ICM) Val d'Aurelle, Montpellier University, Montpellier, France
| | - Séverine Guiu
- Institut du Cancer de Montpellier (ICM) Val d'Aurelle, Montpellier University, Montpellier, France.,IRCM INSERM U1194, Montpellier, France
| | | | | | - Mario Campone
- Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | | | | | - Marie Chaix
- Centre Georges Francois Leclerc, Dijon, France
| | | | | | - Lionel Uwer
- Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | | | | | | | | | | | - Paul Cottu
- Etablissement Hospitalier Institut Curie, Paris, France
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Hoenigl M, Hassan A, Moore DJ, Anderson PL, Corado K, Dubé MP, Ellorin EE, Blumenthal J, Morris SR. Predictors of Long-Term HIV Pre-exposure Prophylaxis Adherence After Study Participation in Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2019; 81:166-174. [PMID: 30865175 PMCID: PMC6522282 DOI: 10.1097/qai.0000000000002003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Efficacy of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men is well documented in randomized trials. After trial completion, participants are challenged with acquiring PrEP on their own and remaining adherent. METHODS This was a follow-up study of the TAPIR randomized controlled multicenter PrEP trial. Participants were contacted after their last TAPIR visit (ie, after study-provided PrEP was discontinued) to attend observational posttrial visits 24 and 48 weeks later. Adherence during TAPIR and posttrial visits was estimated by dried blood spot intracellular tenofovir diphosphate levels (adequate adherence defined as tenofovir diphosphate levels >719 fmol/punch). Binary logistic regression analysis assessed predictors of completing posttrial visits and PrEP adherence among participants completing ≥1 visit. RESULTS Of 395 TAPIR participants who were on PrEP as part of the TAPIR trial for a median of 597 days (range 3-757 days), 122 (31%) completed ≥1 posttrial visit (57% of University of California San Diego participants completed posttrial visits, whereas this was 13% or lower for other study sites). Among participants who completed ≥1 posttrial visit, 57% had adequate adherence posttrial. Significant predictors of adequate adherence posttrial were less problematic substance use, higher risk behavior, and adequate adherence in year 1 of TAPIR. CONCLUSION More than half of PrEP users followed after trial completion had successfully acquired PrEP and showed adequate adherence. Additional adherence monitoring and intervention measures may be needed for those with low PrEP adherence and problematic substance use during the first year of trial.
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Affiliation(s)
- Martin Hoenigl
- University of California San Diego (UCSD), San Diego, California, United States
| | - Adiba Hassan
- University of California San Diego (UCSD), San Diego, California, United States
| | - David J. Moore
- University of California San Diego (UCSD), San Diego, California, United States
| | - Peter L. Anderson
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katya Corado
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Michael P. Dubé
- Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Eric E. Ellorin
- University of California San Diego (UCSD), San Diego, California, United States
| | - Jill Blumenthal
- University of California San Diego (UCSD), San Diego, California, United States
| | - Sheldon R. Morris
- University of California San Diego (UCSD), San Diego, California, United States
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Mariño Z, Pascasio-Acevedo JM, Gallego A, Diago M, Baliellas C, Morillas R, Prieto M, Moreno JM, Sánchez-Antolín G, Vergara M, Forné M, Fernández I, Castro MA, Pascual S, Gómez A, Castells L, Montero JL, Crespo J, Calleja JL, García-Samaniego J, Carrión JA, Arencibia AC, Blasco A, López-Núñez C, Sánchez-Ruano JJ, Gea-Rodríguez F, Giráldez Á, Cabezas J, Hontangas V, Torras X, Castellote J, Romero-Gómez M, Turnes J, de Artaza T, Narváez I, Cuervas-Mons V, Forns X. High efficacy of Sofosbuvir plus Simeprevir in a large cohort of Spanish cirrhotic patients infected with genotypes 1 and 4. Liver Int 2017; 37:1823-1832. [PMID: 28481460 DOI: 10.1111/liv.13470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/26/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Hepatitis C (HCV) therapy with Sofosbuvir (SOF)/Simeprevir (SMV) in clinical trials and real-world clinical practice, showed high rates of sustained virological response (SVR) in non-cirrhotic genotype (GT)-1 and GT-4 patients. These results were slightly lower in cirrhotic patients. We investigated real-life effectiveness and safety of SOF/SMV with or without ribavirin (RBV) in a large cohort of cirrhotic patients. METHODS This collaborative multicentre study included data from 968 patients with cirrhosis infected with HCV-GT1 or 4, treated with SOF/SMV±RBV in 30 centres across Spain between January-2014 and December-2015. Demographic, clinical, virological and safety data were analysed. RESULTS Overall SVR was 92.3%; the majority of patients were treated with RBV (62%) for 12 weeks (92.4%). No significant differences in SVR were observed between genotypes (GT1a:94.3%; GT1b:91.7%; GT4:91.1%). Those patients with more advanced liver disease (Child B/C, MELD≥10) or portal hypertension (platelet count≤100×109 /L, transient elastography≥21 Kpa) showed significantly lower SVR rates (84.4%-91.9%) than patients with less advanced liver disease (93.8%-95.9%, P<.01 in all cases). In the multivariate analysis, the use of RBV, female gender, baseline albumin≥35 g/L, MELD<10 and lack of exposure to a triple therapy regimen were independent predictors of SVR (P<.05). Serious adverse events (SAEs) and SAE-associated discontinuation events occurred in 5.9% and 2.6%. CONCLUSIONS In this large cohort of cirrhotic patients managed in the real-world setting in Spain, SOF/SMV±RBV yielded to excellent SVR rates, especially in patients with compensated liver cirrhosis. In addition, this combination showed to be safe, with low rates of SAEs and early discontinuations.
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Affiliation(s)
- Zoe Mariño
- Liver Unit, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Juan M Pascasio-Acevedo
- Clinical Management Unit of Digestive Diseases, Hospital Universitario Virgen del Rocío, CIBERehd, Sevilla, Spain
| | - Adolfo Gallego
- Liver Unit, Hospital Santa Creu i Sant Pau, CIBERehd, Barcelona, Spain
| | - Moisés Diago
- Digestive Diseases, Hospital Universitario General, Valencia, Spain
| | - Carme Baliellas
- Liver Unit, Hospital Universitari Bellvitge-Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Morillas
- Liver Unit, Hospital Germans Trias i Pujol, CIBERehd, Badalona, Spain
| | - Martín Prieto
- Liver Unit, Hospital Universitario La Fe, Valencia, Spain
| | - José M Moreno
- Department of Gastroenterology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Mercedes Vergara
- Liver Unit, Servei d'Aparell Digestiu, Parc Tauli Sabadell Hospital Universitari, Universitat Autónoma Barcelona, Sabadell, Spain
| | - Montserrat Forné
- Liver Unit, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
| | | | - María A Castro
- Internal Medicine, Grupo de Virología Clínica, Instituto Investigación Biomédica A Coruña (INIBIC)-Hospital Universitario A Coruña, A Coruña, Spain
| | - Sonia Pascual
- Liver Unit, Hospital General Universitario Alicante, CIBERehd, Alicante, Spain
| | - Alexandra Gómez
- Liver Unit, Hospital Universitario Donostia, San Sebastian, Spain
| | - Lluis Castells
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall Hebron, CIBERehd, Barcelona, Spain
| | - José L Montero
- Liver Unit, Hospital Universitario Reina Sofía, CIBERehd, Córdoba, Spain
| | - Javier Crespo
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | - José L Calleja
- Liver Unit, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, CIBERehd, Madrid, Spain
| | | | - Jose A Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ana C Arencibia
- Liver Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Alejandro Blasco
- Digestive Diseases, Hospital de Sant Joan Despi Moises Broggi, Barcelona, Spain
| | - Carmen López-Núñez
- Digestive Diseases, Hospital Universitari Dr.Josep Trueta, Girona, Spain
| | | | | | - Álvaro Giráldez
- Clinical Management Unit of Digestive Diseases, Hospital Universitario Virgen del Rocío, CIBERehd, Sevilla, Spain
| | - Joaquín Cabezas
- Gastroenterology and Hepatology Department, University Hospital Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain
| | | | - Xavier Torras
- Liver Unit, Hospital Santa Creu i Sant Pau, CIBERehd, Barcelona, Spain
| | - Jose Castellote
- Liver Unit, Hospital Universitari Bellvitge-Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Juan Turnes
- Digestive Diseases, Complejo Hospitalario Universitario de Pontevedra and IISGS, Pontevedra, Spain
| | - Tomás de Artaza
- Digestive Diseases, Hospital Universitario de Toledo, Toledo, Spain
| | | | - Valentín Cuervas-Mons
- Liver Unit, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, CIBERehd, Madrid, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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7
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Tacke F, Günther R, Buggisch P, Klinker H, Schober A, John C, Lutz T, Pfeiffer-Vornkahl H, Niederau C, Cornberg M, Sarrazin C, Mauss S. Treatment of HCV genotype 2 with sofosbuvir and ribavirin results in lower sustained virological response rates in real life than expected from clinical trials. Liver Int 2017; 37:205-211. [PMID: 27428297 DOI: 10.1111/liv.13206] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/11/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) infections with genotype 2 (GT2) are generally considered as easy to treat. The current standard therapy is 12 weeks of sofosbuvir and ribavirin. However, sustained virological response (SVR) rates varied substantially in distinct subgroups. Therefore, re-assessing the efficacy of interferon-free therapy in cohorts with larger patient numbers is warranted. METHODS The German Hepatitis C registry is a national multicenter cohort. Patients are treated at the discretion of the physician. Data are collected by a web-based data system and confirmed by plausibility checks and on-site monitoring. RESULTS A total of 265 (4.3%) of 6034 patients enrolled in the registry were infected with GT2, and 236 had initiated treatment (60% males, 98% Caucasian, median age 54 years). Treatment with sofosbuvir and ribavirin for 12 weeks achieved SVR at week 12 post-treatment (SVR12) in 136/164 (83%) patients. SVR12 rates for this regimen were 80% (35/44) in treatment-experienced patients, 74% (20/27) in cirrhotics and 75% (21/28) in patients with HCV-RNA ≥6 million IU/mL. The overall SVR rate in patients treated with sofosbuvir/ribavirin 12 weeks per protocol (PP), excluding therapy discontinuation or lost to follow-up, was 135/151 (89%). PP SVR12 rates were 91% for treatment naïve, 83% for cirrhotic and 80% for treatment-experienced patients respectively. CONCLUSIONS In this large GT2 cohort, sofosbuvir and ribavirin for 12 weeks achieved lower SVR rates compared to treatment outcomes expected from phase 3 trials. These findings highlight the need for establishing alternative treatment strategies for GT2 patients, especially in patients with unfavourable outcome factors.
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Affiliation(s)
- Frank Tacke
- Department of Medicine III, University Hospital Aachen, Aachen, Germany
| | - Rainer Günther
- Universitätsklinikum Schleswig-Holstein (UKSH), Kiel, Germany
| | - Peter Buggisch
- IFI-Institute for Interdisciplinary Medicine, Hamburg, Germany
| | | | | | | | | | | | - Claus Niederau
- St. Josef-Hospital, Katholisches Klinikum Oberhausen, Oberhausen, Germany
| | | | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
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