2020 Taiwan consensus statement on the management of hepatitis C: part (I) general population

Yu, Ming‐Lung; Chen, Pei‐Jer; Dai, Chia‐Yen; Hu, Tsung–Hui; Huang, Chung‐Feng; Huang, Yi-Hsiang; Hung, Chao‐Hung; Lin, Chun-Yen; Liu, Chun‐Jen; Peng, Cheng‐Yuan; H, Lin; Kao, Jia‐Horng; Chuang, Wan‐Long

doi:10.1016/j.jfma.2020.04.003

Cited by 67 publications

(83 citation statements)

References 172 publications

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“…The National Health Insurance Administration (NHIA) of Taiwan began to reimburse DAAs in January 2017, and there are currently no limitations for treating CHC patients with DAAs. The treatment regimens and strategies conformed to the regional consensus [13,14] and regulations of the Health and Welfare Department of Taiwan [15]. The treatment regimens in the current study included sofosbuvir/ledipasvir, sofosbuvir/velpatasvir, elbasvir/grazoprevir and glecaprevir/pibrentasvir.…”

Section: Daa Treatmentmentioning

confidence: 99%

Scaling up the in-hospital hepatitis C virus care cascade in Taiwan

Huang

Yeh

et al. 2021

Clin Mol Hepatol

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Background/Aims: Obstacles exist in facilitating hepatitis C virus (HCV) care cascade. To increase timely and accurate diagnosis, disease awareness and accessibility, in-hospital HCV reflex testing followed by automatic appointments and a late call-back strategy (R.N.A. model) was applied. We aimed to compare the HCV treatment rate of patients treated with this strategy compared to those without.Methods: One hundred and twenty-five anti-HCV seropositive patients who adopted the R.N.A. model in 2020 and another 1,396 controls treated in 2019 were enrolled to compare the gaps in accurate HCV RNA diagnosis to final treatment allocation.Results: The HCV RNA testing rate was significantly higher in patients who received reflex testing than in those without reflex testing (100% vs. 84.8%, P<0.001). When patients were stratified according to the referring outpatient department, a significant improvement in the HCV RNA testing rate was particularly noted in patients from non-hepatology departments (100% vs. 23.3%, P<0.001). The treatment rate in HCV RNA seropositive patients was 83% (83/100) after the adoption of the R.N.A. model, among whom 96.1% and 73.9% of patients were from the hepatology and non-hepatology departments, respectively. Compared to subjects without R.N.A. model application, a significant improvement in the treatment rate was observed for patients from non-hepatology departments (73.9% vs. 27.8%, P=0.001). The application of the R.N.A. model significantly increased the in-hospital HCV treatment uptake from 6.4% to 73.9% for patients from non-hepatology departments (P<0.001).Conclusions: The care cascade increased the treatment uptake and set up a model for enhancing in-hospital HCV elimination.

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Section: Daa Treatmentmentioning

confidence: 99%

Scaling up the in-hospital hepatitis C virus care cascade in Taiwan

Huang

Yeh

et al. 2021

Clin Mol Hepatol

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“…Similarly, patients with FIB-4 value lower than 1.89 had 88.1% could be discharged from the surveillance plan Table 3. In the 2020 Taiwan consensus statement on the management of hepatitis C, patient infected with genotype 3, interferonexperienced, and with compensated cirrhosis (F4) need further consideration for regiment and duration adjustment [43]. High NPV for F4 could be useful to exclude patients with cirrhosis.…”

Section: Plos Onementioning

confidence: 99%

“…Accurate assessment of liver fibrosis is mandatory because the treatment algorithm of antiviral therapy for HCV are mainly based on degree of hepatic fibrosis [15][16][17]. Patients with advanced fibrosis are at high risk of hepatocellular carcinoma, even under HBV suppression or HCV eradication [18,19].…”

Section: Introductionmentioning

confidence: 99%

The applicability of non-invasive methods for assessing liver fibrosis in hemodialysis patients with chronic hepatitis C

et al. 2020

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Background The accurate assessment of liver fibrosis among hemodialysis patients with chronic hepatitis C (CHC) is important for both treatment and for follow up strategies. Applying the non-invasive methods in general population with viral hepatitis have been successful but the applicability of the aminotransferase/platelet ratio index (APRI) or the fibrosis-4 index (FIB-4) in hemodialysis patients need further evaluation. Materials and methods We conducted a prospective, multi-center, uremic cohort to verify the applicability of APRI and FIB-4 in identifying liver fibrosis by reference with the standard transient elastography (TE) measures. Results There were 116 CHC cases with valid TE were enrolled in our analysis. 46 cases (39.6%) were classified as F1, 35 cases (30.2%) as F2, 11 cases (9.5%) as F3, and 24 cases (20.7%) as F4, respectively. The traditional APRI and FIB-4 criteria did not correctly identify liver fibrosis. The optimal cut-off value of APRI was 0.28 and of FIB-4 was 1.91 to best excluding liver cirrhosis with AUC of 76% and 77%, respectively. The subgroup analysis showed that female CHC hemodialysis patients had better diagnostic accuracy with 74.1% by APRI. And CHC hemodialysis patients without hypertension had better diagnostic accuracy with 78.6% by FIB-4. Conclusions This study confirmed the traditional category level of APRI and FIB-4 were unable to identify liver fibrosis of CHC hemodialysis patients. With the adjusted cut-off value, APRI and FIB-4 still showed suboptimal diagnostic accuracy. Our results suggest the necessary of TE measures for liver fibrosis in the CHC uremic population.

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“…Direct-acting antivirals (DAAs) have become the first-line treatment for HCV infection. [13][14][15][16] Compared to interferon-based treatment, 17,18 DAA therapy is generally more tolerable, requires a shorter duration, and is more effective. However, the guidelines also highlight the importance of considering and monitoring potential drug-drug interactions (DDIs) between DAAs and comedications.…”

Section: Introductionmentioning

confidence: 99%

“…However, the guidelines also highlight the importance of considering and monitoring potential drug-drug interactions (DDIs) between DAAs and comedications. [13][14][15][16] To avoid potential DDIs and to optimize patient safety and treatment efficacy, it is important to review all the medications taken by the patient, including over-the-counter preparations and recreational drugs, before and during DAA therapy.…”

Section: Introductionmentioning

confidence: 99%

Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis

et al. 2021

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Background/Aims: Direct‐acting antivirals (DAAs) have been approved for hepatitis C virus (HCV) treatment in patients with end-stage renal disease (ESRD) on hemodialysis. Nevertheless, the complicated comedications and their potential drug-drug interactions (DDIs) with DAAs might limit clinical practice in this special population.Methods: The number, class, and characteristics of comedications and their potential DDIs with five DAA regimens were analyzed among HCV-viremic patients from 23 hemodialysis centers in Taiwan.Results: Of 2,015 hemodialysis patients screened in 2019, 169 patients seropositive for HCV RNA were enrolled (mean age, 65.6 years; median duration of hemodialysis, 5.8 years). All patients received at least one comedication (median number, 6; mean class number, 3.4). The most common comedication classes were ESRD-associated medications (94.1%), cardiovascular drugs (69.8%) and antidiabetic drugs (43.2%). ESRD-associated medications were excluded from DDI analysis. Sofosbuvir/velpatasvir/voxilaprevir had the highest frequency of potential contraindicated DDIs (red, 5.6%), followed by glecaprevir/pibrentasvir (4.0%), sofosbuvir/ledipasvir (1.3%), sofosbuvir/velpatasvir (1.3%), and elbasvir/grazoprevir (0.3%). For potentially significant DDIs (orange, requiring close monitoring or dose adjustments), sofosbuvir/velpatasvir/voxilaprevir had the highest frequency (19.9%), followed by sofosbuvir/ledipasvir (18.2%), glecaprevir/pibrentasvir (12.6%), sofosbuvir/velpatasvir (12.6%), and elbasvir/grazoprevir (7.3%). Overall, lipid-lowering agents were the most common comedication class with red-category DDIs to all DAA regimens (n=62), followed by cardiovascular agents (n=15), and central nervous system agents (n=10).Conclusions: HCV-viremic patients on hemodialysis had a very high prevalence of comedications with a broad spectrum, which had varied DDIs with currently available DAA regimens. Elbasvir/grazoprevir had the fewest potential DDIs, and sofosbuvir/velpatasvir/voxilaprevir had the most potential DDIs.

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2020 Taiwan consensus statement on the management of hepatitis C: part (I) general population

Cited by 67 publications

References 172 publications

Scaling up the in-hospital hepatitis C virus care cascade in Taiwan

Scaling up the in-hospital hepatitis C virus care cascade in Taiwan

The applicability of non-invasive methods for assessing liver fibrosis in hemodialysis patients with chronic hepatitis C

Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis

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