1
|
Cornberg M, Petersen J, Schober A, Mauss S, Böker KHW, Link R, Günther R, Serfert Y, Pfeiffer-Vornkahl H, Manns MP, Sarrazin C, Hüppe D, Berg T, Niederau C. Real-world use, effectiveness and safety of anti-viral treatment in chronic hepatitis C genotype 3 infection. Aliment Pharmacol Ther 2017; 45:688-700. [PMID: 28078723 DOI: 10.1111/apt.13925] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 11/27/2016] [Accepted: 12/09/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Treatment of chronic hepatitis C genotype 3 (GT3) is more challenging compared with other genotypes. Since 2014, several new treatment regimens have been approved but sometimes based on limited data. AIM To validate the use, effectiveness and safety of anti-viral treatment in chronic hepatitis C genotype 3 infection under real-word conditions. METHODS The German Hepatitis C-Registry is a large national non-interventional real-world study for patients with chronic hepatitis C. A total of 1322 GT3 patients were enrolled (211 untreated and 1111 treated patients). RESULTS Between February 2014 and September 2015, five different treatment strategies have been used (PegIFN+RBV, PegIFN+RBV+SOF, SOF+RBV, DCV+SOF±RBV, LDV/SOF±RBV). Treatment uptake and use of treatment concepts changed markedly and rapidly during the study influenced by new approvals, guideline recommendations, and label updates. PegIFN-based therapies constantly declined while DCV-based therapies increased with one interruption after the approval of LDV/SOF, which was frequently used until new guidelines recommended not using this combination for GT3. Per-protocol SVR ranged from 80.9% in the PegIFN+RBV group to 96.1% in PegIFN+RBV+SOF treated patients. Treatment-experienced patients with cirrhosis showed a suboptimal SVR of 68% for SOF+RBV but a high SVR of 90-95% for DCV+SOF±RBV. The safety analysis showed more adverse events and a stronger decline of haemoglobin for RBV containing regimens. CONCLUSIONS Real-world data can validate the effectiveness and safety for treatment regimens that had previously been approved with limited data, in particular for specific subgroups of patients. The present study demonstrates how rapid new scientific data, new treatment guidelines, new drug approvals and label changes are implemented into routine clinical practice today.
Collapse
Affiliation(s)
- M Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany and German Center for Infection Research (DZIF), Partner-site Hannover-Braunschweig, Germany
| | - J Petersen
- IFI-Institute for Interdisciplinary Medicine, Hamburg, Germany
| | - A Schober
- Hepatologische Praxis, Göttingen, Germany
| | - S Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | | | - R Link
- MVZ Offenburg, Offenburg, Germany
| | - R Günther
- Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Y Serfert
- Leberstiftungs-GmbH Deutschland, Hannover, Germany
| | | | - M P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany and German Center for Infection Research (DZIF), Partner-site Hannover-Braunschweig, Germany
| | - C Sarrazin
- St.-Josefs-Hospital Wiesbaden and University Hospital Frankfurt, Frankfurt, Germany
| | - D Hüppe
- Hepatologische Schwerpunktpraxis Herne, Herne, Germany
| | - T Berg
- University Hospital Leipzig, Leipzig, Germany
| | - C Niederau
- St. Josef-Hospital Katholisches Klinikum Oberhausen, Oberhausen, Germany
| |
Collapse
|
2
|
Stahmeyer JT, Krauth C, Bert F, Pfeiffer-Vornkahl H, Alshuth U, Hüppe D, Mauss S, Rossol S. Costs and outcomes of treating chronic hepatitis C patients in routine care - results from a nationwide multicenter trial. J Viral Hepat 2016; 23:105-15. [PMID: 26411532 DOI: 10.1111/jvh.12471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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] [Received: 11/10/2014] [Accepted: 08/18/2015] [Indexed: 12/14/2022]
Abstract
Viral hepatitis is a major public health problem affecting millions of people worldwide. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The aim of the study was to assess outcomes and costs of treating patients with chronic hepatitis C in clinical practice in Germany. We carried out a prospective noninterventional study. Information on treatment outcomes, resource utilization and quality of life was provided by 281 physicians throughout Germany. Data of 3708 monoinfected HCV-patients treated between 2008 and 2011 were analysed. Therapy consisted of peginterferon/ribavirin. Mean age of patients was 43.7 years, 60.3% were male and estimated duration of infection was 13.6 years. Predominantly genotype 1 (61.3%) or 3 (28.5%) infections were observed. Sustained viral response (SVR)-rates in most frequently observed genotypes were 49.2% in GT-1 and 61.9% in GT-3 treatment-naive patients (Relapser: GT-1: 35.3% and GT-3: 57.3%; Nonresponder: GT-1: 25.0% and GT-3: 33.3%). Average treatment costs were lowest in treatment-naive patients (€18 965) and higher in patients who failed previous treatments (relapsers: €24 753; nonresponders: €19 511). Differences according to genotype were observed. Average costs per SVR in treatment-naive patients were €44 744 for GT-1 and €22 218 for GT-3. Treatment was associated with a decrease in quality of life; post-treatment quality of life was higher in patients achieving SVR. Our insight on real-life treatment outcomes and costs can serve as a reference for a comparison with other treatments. There is high need for short-term and long-term cost-effectiveness analysis in real-life settings as newly introduced treatment strategies with direct acting antivirals result in high SVR-rates but are more costly.
Collapse
Affiliation(s)
- J T Stahmeyer
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - C Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - F Bert
- Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt/M, Germany
| | - H Pfeiffer-Vornkahl
- Factum - Company for Statistics, Scientific Information and Communication mbH, Offenbach, Germany
| | - U Alshuth
- Virology, Roche Pharma AG, Grenzach-Wyhlen, Germany
| | - D Hüppe
- Center of Gastroenterology, Herne, Germany
| | - S Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | - S Rossol
- Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt/M, Germany
| |
Collapse
|
3
|
Mauss S, Böker K, Buggisch P, Christensen S, Hofmann WP, Schott E, Pfeiffer-Vornkahl H, Alshuth U, Hüppe D. Real-life experience with first generation HCV protease inhibitor therapy in Germany: The prospective, non-interventional PAN cohort. Z Gastroenterol 2015; 53:644-54. [PMID: 26167694 DOI: 10.1055/s-0034-1399383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS The efficacy and safety of peginterferon alfa-2a (PEG-IFN) plus ribavirin (RBV) and either boceprevir (BOC) or telaprevir (TVR), and physician adherence to treatment algorithms were evaluated in patients included in an ongoing non-interventional study (PAN) enrolling adults with chronic hepatitis C virus (HCV) infection managed in German office-based practices. METHODS The analysis included HCV genotype 1-infected, treatment-naïve and treatment-experienced patients treated with BOC or TVR. Demographic, treatment history, virological response, safety, and patient management data were collected. RESULTS Of a total 1087 patients, 58.1 % achieved sustained virological responses (SVR). Response rates were higher in treatment-naïve (BOC 55 %; TVR 63.4 %) and prior relapse patients (BOC 63.2 %; TVR 74.5 %) versus previous null-responders (BOC 14.3 %; TVR 25 %). The most commonly reported adverse event overall was fatigue (60.6 %); 45.8 % patients experienced hemoglobin < 10 g/dL. Patients with cirrhosis had lower rates of SVR versus those without (42.9 % vs. 60.7 %, respectively), and had a higher incidence of serious adverse events (SAEs) (16.7 % vs. 8.6 %, respectively) and treatment discontinuation (44.6 % vs. 25.2 %, respectively). According to recommended response-guided treatment algorithms, about 70 % of patients were managed appropriately, 11/10 % (BOC/TVR) received unnecessarily extended therapy, and 19/7 % (BOC/TVR) received inappropriately shortened therapy. CONCLUSIONS The efficacy and safety of BOC- and TVR-based triple therapy in this large, "real-world" cohort were largely comparable to that reported in pivotal clinical trials, although SVR rates were lower overall. Recommended futility or treatment extension rules were violated in a substantial proportion of patients with potential implications for response, adverse events and costs.
Collapse
Affiliation(s)
- S Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | - K Böker
- Center for Hepatology, Hannover, Germany
| | - P Buggisch
- ifi -Institute for Interdisciplinary Medicine, Hamburg, Germany
| | - S Christensen
- Center for Interdisciplinary Medicine, Muenster, Germany
| | | | - E Schott
- Department of Hepatology and Gastroenterology, Charité, CVK, Berlin, Germany
| | | | - U Alshuth
- Roche Pharma AG, Grenzach-Wyhlen, Germany
| | - D Hüppe
- Center of Gastroenterology, Herne, Germany
| |
Collapse
|
4
|
Mauss S, Berger F, Schober A, Moog G, Heyne R, John C, Pape S, Hueppe D, Pfeiffer-Vornkahl H, Alshuth U. Screening for autoantibodies in chronic hepatitis C patients has no effect on treatment initiation or outcome. J Viral Hepat 2013; 20:e72-7. [PMID: 23490392 DOI: 10.1111/jvh.12011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 08/01/2012] [Indexed: 12/13/2022]
Abstract
Autoantibodies in hepatitis C virus-infected patients may indicate autoimmune hepatitis or other immune-mediated diseases. This may impact safety and efficacy of interferon-based therapy of chronic hepatitis C. We investigated the association between a positive test result for a variety of autoantibodies and the initiation and efficacy of therapy for chronic hepatitis C. We analysed an observational cohort of 24 306 patients for an association between autoantibodies and treatment outcome. 8241 patients were tested simultaneously for antinuclear antibodies (ANA), liver kidney microsomal antibodies (LKM), smooth muscle antibodies (SMA) and antimitochondrial antibodies (AMA). Matched-pair analysis was performed matching one autoantibody-positive patient to three controls. Control patients had negative tests for all four antibodies. Analyses were performed for patients with a single positive autoantibody test and for patients with multiple positive autoantibody tests. A positive test result for ANA, LKM, SMA or AMA did not affect the physician's decision to initiate therapy with pegylated interferon and ribavirin. In addition, a positive test for one or multiple autoantibodies did not adversely affect sustained virologic response. There was no difference in fibrosis stage or alanine transaminase at baseline or during therapy irrespective of antibody status. Thyroid dysfunction was more frequent in patients with positive LKM antibodies (P = 0.004). Initiation of therapy for chronic hepatitis C and outcome were not affected by the presence of ANA, LKM, SMA or AMA. Routine testing of these autoantibodies seems not warranted. Determination of autoantibodies should be guided by individualized clinical decisions.
Collapse
Affiliation(s)
- S Mauss
- Center for HIV and Hepatogastroenterology, Dusseldorf, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Mauss S, Berger F, Vogel M, Pfeiffer-Vornkahl H, Alshuth U, Rockstroh J, Niederau C, Hüppe D. Treatment Results of Chronic Hepatitis C Genotype 5 and 6 Infections in Germany. Z Gastroenterol 2012; 50:441-4. [DOI: 10.1055/s-0031-1282072] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- S. Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - F. Berger
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - M. Vogel
- Department of Internal Medicine III, Bonn, Germany
| | - H. Pfeiffer-Vornkahl
- factum - company for statistics, scientific information and communication mbH, Offenbach, Germany
| | - U. Alshuth
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - J. Rockstroh
- Department of Internal Medicine I, Bonn, Germany
| | - C. Niederau
- Department of Internal Medicine, Katholische Kliniken Oberhausen, Oberhausen, Germany
| | - D. Hüppe
- Practice for Gastroenterology, Herne, Germany
| |
Collapse
|