Chronic hepatitis C patients prior to broad access to interferon-free treatments in Germany

Abstract

In 2014, the first interferon-free treatment options for chronic Hepatitis C (CHC) became available in Europe introducing a new era of highly effective and well tolerated oral treatment options for CHC. The data from the cross-sectional study CURRENT-C highlights the epidemiological characteristics of patients with CHC in Germany. During the period that the study was conducted, the approval of the combination drugs for the treatment of CHC was imminent.Between June and November 2014, 1471 CHC-patients not receiving anti-HCV treatment were included nationwide in 40 German centers specializing in viral hepatitis. The mean age was 52.4 years with 41.2 % of the patients being female. Presumed route of infection in male patients was most frequently drug use (46.2 %) and blood products in females (22.8 %). The route of infection was unknown in 28.2 % of male and 43.1 % of female patients. Compared to male patients, female patients were older (55.6 vs. 50.1 years) and longer diagnosed with HCV (18 vs. 15 years). First language of the patients was most frequently German (72.2 %), followed by Russian (14.2 %), and Polish (2.9 %). HCV genotype (GT) 1 was found in 73.8 % (1a 29.0 %, 1b 38.4 %), GT2 in 3.5 %, GT3 in 18.3 %, GT4 in 4.2 %, GT5 in 0.2 %, and GT6 in 0.3 %. Liver cirrhosis was diagnosed in 15.7 % of the patients (17.1 % male, 13.7 % female). 43.2 % of the patients had already received HCV treatment, most frequently dual therapy with pegIFN + RBV (75.8 %) or triple therapy with telaprevir or boceprevir (20.3 %). Compared to treatment-naïve patients, pretreated HCV patients were older (55.1 vs. 50.3 years) and more frequently had liver cirrhosis as clinical diagnosis (22.2 % vs. 10.8 %). Patients scheduled for HCV treatment within the next 3 months had higher rates of pre-treatment (49.4 % vs. 37.0 %), and liver cirrhosis (21.4 % vs. 10.0 %).Compared to epidemiological data of Hüppe et al. 1 from 2003 to 2006, Klass et al. 2 stated in 2012 in a comparable setting that the German CHC population were older and had more advanced liver disease. The current data seem to support this ongoing trend towards more difficult to treat patients with an urgent need for new treatment options.

Barriers to initiation of hepatitis C virus therapy in Germany: A retrospective, case-controlled study

“…Concerns regarding adherence of patients to both treatment and care appointments are supported by other retrospective studies of patients with CHC that have shown as many as 30-67% of patients diagnosed with CHC and not initiating treatment did so as a result of poor adherence to clinic appointments or loss to follow-up [27,37]. Similar to this study, others have also shown that advanced age [25], comorbidities (in particular psychiatric illness), as well as alcohol and drug abuse [37], can be associated with nontreatment in patients with CHC [27,28]. One recent study detailing physician attitudes towards CHC treatment in patients receiving opioid agonist treatment (OAT) in the United States, cited the perceived need for stable alcohol use and OAT, concerns regarding adherence, and challenging and marginalised patient lives as potential barriers to CHC treatment in this population [29].…”

“…However, our findings show that despite the availability of DAAs, many patients diagnosed with CHC still did not receive treatment. Furthermore, compared with the earlier CURRENT-C study, in a greater proportion of patients who did not receive therapy, the choice was made to not initiate therapy at all, rather than postponing to a later date [25]. In addition to this, the proportion of patients not initiating treatment as a result of patient preference in the present study is almost twice that reported in the earlier study [25].…”

“…The original CURRENT-C study, conducted in the interferon/early DAA era [25], reported that 24% of patients diagnosed with CHC infection refused treatment, primarily for fear of treatment toxicity or for family or job reasons [25]. Of those patients delaying treatment to a later date, the vast majority (80%) were said to be waiting until the approval of broadly accessible interferon-free therapies [25]. However, our findings show that despite the availability of DAAs, many patients diagnosed with CHC still did not receive treatment.…”

“…Furthermore, compared with the earlier CURRENT-C study, in a greater proportion of patients who did not receive therapy, the choice was made to not initiate therapy at all, rather than postponing to a later date [25]. In addition to this, the proportion of patients not initiating treatment as a result of patient preference in the present study is almost twice that reported in the earlier study [25]. Notably, the historical barriers to treatment initiation identified in the first CURRENT-C study (older age, drug use, and comorbidities), involving patients for whom clinical and realworld evidence now support use [31][32][33][34][35][36], were still evident in this investigation.…”

Prevalence of Hepatitis B, C, and D in Germany: Results From a Scoping Review

“…The 39 publications covering HBV prevalence were on studies conducted between 1996 and 2016. The prevalence of HBV in the GP, including proxy populations, was reported in 13 publications of which 11 were at national level ( 5 , 10 , 13 , 25 , 27 , 30 – 32 , 35 , 58 , 59 ). One publication did not describe on which level the data were from ( 16 ).…”