“…The present study showed that the concomitant use of ribavirin with direct-acting antivirals for the treatment of chronic hepatitis C in the Nonresponders, n (%) 1 (2,2) 0 (0) 2 (1,3) 1 (2,0) 1 (2,0) 2 (4,0) ----7 (1,9) Groups: 1-SOF+DCV 12 weeks; 2-SOF+DCV 24 weeks; 3-SOF+DCV+RBV 12 weeks; 4-SOF+DCV+RBV 24 weeks; 5-SOF+SMV 12 weeks; 6-SOF +SMV+RBV 12 weeks.…”
Section: Discussionmentioning
confidence: 58%
“…Hepatitis C is a silent disease that often has no clinical signs and symptoms and is a serious public health problem, as it presents great potential for chronicity. Approximately 71 million people worldwide are infected with the chronic form of the disease . There are still no vaccines against the hepatitis C virus (HCV), although a great deal of research has focused on this goal …”
Section: Introductionmentioning
confidence: 99%
“…Approximately 71 million people worldwide are infected with the chronic form of the disease. 1,2 There are still no vaccines against the hepatitis C virus (HCV), although a great deal of research has focused on this goal. 3,4 In Brazil, approximately 657,000 individuals are infected with HCV, representing 0.7% of the population.…”
Purpose
To identify factors associated with the development of adverse drug reactions (ADR) in ribavirin therapeutic regimens.
Methods
A multicenter, prospective study was conducted in three public health hospitals in Rio de Janeiro between November 2015 and March 2018. Inclusion criteria were defined by patient follow‐up at pharmaceutical consultation at the time of drug dispensing as those who used sofosbuvir in combination with simeprevir, daclatasvir, and/or ribavirin. All patients were invited to participate in the study during the first interview. Adverse drug reactions were reported according to the treatment regimen and frequency of occurrence. Statistical analysis was used to compare adverse reactions between treatments and their associated factors.
Results
A total of 405 patients were included in the study (mean age 59.6 ± 9.6 years); 61.0% were female, 88.1% were infected with genotype 1, and 65.4% were cirrhotic. The most prescribed treatment was the combination of sofosbuvir, daclatasvir, and ribavirin (55.3%). The majority of patients reported at least one ADR during treatment (83.2%), of which fatigue, anemia, and headache were the most common. Being female (OR = 1.86, [1.08‐3.20]) and use of ribavirin (OR: 2.39; 95% CI [1.38‐4.13]) were predictors for the development of ADR, which was also associated with development of anemia (OR: 10.28; 95% CI: [5.78‐18.30]). Treatment efficacy was 98.1%.
Conclusions
Direct‐acting antiviral has been shown to be safe and effective. Therefore, use of ribavirin is questionable due to associated adverse reactions and similar efficacy to other treatments.
“…The present study showed that the concomitant use of ribavirin with direct-acting antivirals for the treatment of chronic hepatitis C in the Nonresponders, n (%) 1 (2,2) 0 (0) 2 (1,3) 1 (2,0) 1 (2,0) 2 (4,0) ----7 (1,9) Groups: 1-SOF+DCV 12 weeks; 2-SOF+DCV 24 weeks; 3-SOF+DCV+RBV 12 weeks; 4-SOF+DCV+RBV 24 weeks; 5-SOF+SMV 12 weeks; 6-SOF +SMV+RBV 12 weeks.…”
Section: Discussionmentioning
confidence: 58%
“…Hepatitis C is a silent disease that often has no clinical signs and symptoms and is a serious public health problem, as it presents great potential for chronicity. Approximately 71 million people worldwide are infected with the chronic form of the disease . There are still no vaccines against the hepatitis C virus (HCV), although a great deal of research has focused on this goal …”
Section: Introductionmentioning
confidence: 99%
“…Approximately 71 million people worldwide are infected with the chronic form of the disease. 1,2 There are still no vaccines against the hepatitis C virus (HCV), although a great deal of research has focused on this goal. 3,4 In Brazil, approximately 657,000 individuals are infected with HCV, representing 0.7% of the population.…”
Purpose
To identify factors associated with the development of adverse drug reactions (ADR) in ribavirin therapeutic regimens.
Methods
A multicenter, prospective study was conducted in three public health hospitals in Rio de Janeiro between November 2015 and March 2018. Inclusion criteria were defined by patient follow‐up at pharmaceutical consultation at the time of drug dispensing as those who used sofosbuvir in combination with simeprevir, daclatasvir, and/or ribavirin. All patients were invited to participate in the study during the first interview. Adverse drug reactions were reported according to the treatment regimen and frequency of occurrence. Statistical analysis was used to compare adverse reactions between treatments and their associated factors.
Results
A total of 405 patients were included in the study (mean age 59.6 ± 9.6 years); 61.0% were female, 88.1% were infected with genotype 1, and 65.4% were cirrhotic. The most prescribed treatment was the combination of sofosbuvir, daclatasvir, and ribavirin (55.3%). The majority of patients reported at least one ADR during treatment (83.2%), of which fatigue, anemia, and headache were the most common. Being female (OR = 1.86, [1.08‐3.20]) and use of ribavirin (OR: 2.39; 95% CI [1.38‐4.13]) were predictors for the development of ADR, which was also associated with development of anemia (OR: 10.28; 95% CI: [5.78‐18.30]). Treatment efficacy was 98.1%.
Conclusions
Direct‐acting antiviral has been shown to be safe and effective. Therefore, use of ribavirin is questionable due to associated adverse reactions and similar efficacy to other treatments.
“…Drug injection is the most important risk factor for the acquisition of HCV infection in large urban centers, especially in young individuals. In addition, the high prevalence in satellite cities may be explained by the large influx of migrants 15,24,28,29 .…”
Introduction: Viral hepatitis is a group of diseases that present high hepatotropism and are related to liver dysfunctions, having either an acute or a chronic course. Their worldwide epidemiology is diverse, with several endemic places, such as South America. The objective of this study was to analyze the epidemiology of viral hepatitis in Brazil, in order to better understand its pattern of distribution and evolution. Method: A temporal aggregation study was conducted using the Viral Hepatitis Database of the Brazilian Ministry of Health. The serological markers used were HBsAg and anti-HCV for hepatitis B and C, respectively. Mortality data were collected from the Mortality Information System for deaths attributed to viral hepatitis. The period analyzed was from 2007 to 2016/17. Results: The incidence was 7.88 (95% CI, 7.30-8.45) for hepatitis B and 11.9 (95% CI, 11.15-12.65) for hepatitis C. Mortality attributed to viral hepatitis was 1.61 (95% CI, 1.35-1.87) deaths per 100,000 people. An analysis of municipal distribution data showed several endemic areas. The Brazilian regions most affected by hepatitis B virus were the northern and southern borders, Santa Catarina coast and Espírito Santo state, while hepatitis C virus was mostly present in metropolitan areas such as Porto Alegre and São Paulo. Conclusions: Viral hepatitis has a diverse geographic distribution in the Brazilian territory, with highly endemic areas. The distribution differs between hepatitis B and hepatitis C viruses.
“…Of those deaths, approximately 47% are attributable to hepatitis B virus (HBV) and 48% to hepatitis C virus (HCV) [ 1 ]. In Brazil, the prevalence of HCV antibodies (anti-HCV) is close to 700,000 [ 2 ]; however, it is possible that this number is only a quarter of the total population actually infected [ 3 ].…”
Hepatitis virus infection is a major public health problem worldwide. Currently, Brazil has almost 700,000 cases. The Brazilian Unified Health System (SUS) provides therapeutic regimens for people infected with hepatitis C virus (HCV). We determined the clinical, laboratory, epidemiologic, and geospatial characteristics of patients infected with HCV treated with second-generation direct-action antivirals (DAAs) in a hospital reference center in São Paulo state, Brazil, using data from file records. A map was constructed using a geographic information system. From 2015 to 2018, 197 individuals received second-generation DAAs (mean age, 57.68 ± 1.36 years; interquartile range, 56.22–59.14 years; 58.9% male; 41.1% female). Genotypes 1a and 1b accounted for 75.7% of cases and the prevalent therapeutic regimen was sofosbuvir/simeprevir. Sustained viral response accounted for 98.9% and the METAVIR score F3/F4 for 50.8%. Increased alanine transferase was significantly correlated with an increase in α-fetoproteins (p = 0.01), and severe necro-inflammatory activity (p = 0.001). Associated comorbidities were found in 71.6%, mainly coronary artery and gastrointestinal disorders. The cumulative incidence in the region was 2.6 per 10,000 inhabitants. Our data highlight the role of reference hospitals in Brazil’s public health system in the treatment of HCV. Low incidence rates demonstrated the fragility of municipalities in the active search for patients.
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