Adherence, persistence, healthcare utilization, and cost benefits of guideline-recommended hepatitis B pharmacotherapy

Han, Steven‐Huy B.; Jing, Wuhua; Mena, Edward; Pinsky, Brett; Tang, Hong; Hebden, Tony; Juday, Timothy

doi:10.3111/13696998.2012.710690

Cited by 12 publications

(12 citation statements)

References 30 publications

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“…From an initial screen of 878 titles, 30 studies providing data for 23,823 patients met our eligibility criteria and were taken through for review (Fig. ) . The majority (23 studies, 17,057 patients) were from high‐income settings, mainly the United States (seven studies), Australia (four studies), and France (three studies).…”

Section: Resultsmentioning

confidence: 99%

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta‐Analysis

Ford

Scourse

Lemoine

et al. 2018

Hepatology Communications

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Successful treatment outcomes for chronic hepatitis B virus (HBV) infection requires high levels of adherence to treatment. We searched three databases and abstracts from two conferences up to January 2018 for studies reporting the proportion of patients who were adherent to HBV antiviral therapy and pooled data using random effects meta‐analysis. We included 30 studies, providing data for 23,823 patients. Overall, adherence to treatment was 74.6% (95% confidence interval [CI] 67.1%‐82.1%). Adherence was similar in high‐income settings (75.1%; 95% CI, 65.4%‐85.0%) and in low‐income and middle‐income settings (72.9%; 95% CI, 57.8%‐88.0%). Reported barriers to adherence included forgetting, limited understanding of the importance of adherence, and change to routine. Conclusion: There is a need to reinforce assessment and reporting of adherence as a routine part of HBV care and to assess the extent to which evidence‐based interventions to improve adherence to medication for human immunodeficiency virus [HIV] and other chronic diseases are effective for HBV infection.

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Section: Resultsmentioning

confidence: 99%

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta‐Analysis

Ford

Scourse

Lemoine

et al. 2018

Hepatology Communications

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“…It is also important for patients who are fully reimbursed for their Nuc therapy but cannot tolerate long‐term therapy of indefinite and unpredictable duration. Like other chronic diseases requiring long‐term therapy, persistence and adherence to oral anti‐HBV therapy are also issues of great concern . Given a 1‐year Nuc persistence rate (drug refill rate) of 81% and only 74.7% in new patients and a medication possession rate ≧80% in only 53.7% of patients treated with ETV or TDF, it is anticipated that hepatitis flare and, even worse, decompensation may likely develop because the patients who stopped Nuc therapy by themselves are conceivably not monitored properly.…”

Section: Discussionmentioning

confidence: 99%

“…Like other chronic diseases requiring long-term therapy, persistence and adherence to oral anti-HBV therapy are also issues of great concern. [13][14][15] Given a 1-year Nuc persistence rate (drug refill rate) of 81% and only 74.7% in new patients 13 and a medication possession rate м80% in only 53.7% of patients treated with ETV or TDF, 14 it is anticipated that hepatitis flare and, even worse, decompensation may likely develop because the patients who stopped Nuc therapy by themselves are conceivably not monitored properly. This stopping rule may help to convince the patients to persist and adhere to Nuc therapy in a foreseeable finite duration of only 2-3 years.…”

Section: Discussionmentioning

confidence: 99%

Off-therapy durability of response to entecavir therapy in hepatitis B e antigen-negative chronic hepatitis B patients

et al. 2013

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The optimal duration of nucelos(t)ide analog (Nuc) treatment in hepatitis B e antigen (HBeAg)-negative patients with chronic hepatitis B virus (HBV) infection is unknown. The Asian Pacific Association for the Study of the Liver (APASL) guidelines recommend that treatment can be discontinued if undetectable HBV-DNA has been documented on three occasions 6 months apart. This study aimed to test this stopping rule in HBeAgnegative chronic hepatitis B (CHB) patients treated with entecavir (ETV). Ninety-five patients (39 cirrhosis) were treated with ETV for a median of 721 (395-1,762) days before stopping therapy and were then monitored with serum HBV DNA and alanine aminotransferase (ALT) at least every 3 months. Within 1 year after stopping ETV therapy, "clinical relapse" (an episode of ALT elevation >2 3 upper limit of normal plus HBV-DNA >2,000 IU/mL) occurred in 43 (45.3%) of the 95 patients. Of the 39 cirrhosis patients, 17 (43.6%) relapsed and one (2.6%) developed decompensation. The median duration until relapse was 230 days (74.4% >6 months). Logistic regression analysis showed that baseline HBV-DNA 2 3 10 5 IU/mL was the only significant independent factor for sustained response. The 1-year relapse rate was 29% in patients with a baseline HBV DNA 2 3 10 5 IU/mL versus 53% in those with HBV DNA >2 3 10 5 IU/mL (P 5 0.027). For the latter, consolidation therapy >64 weeks reduced the relapse rate to 33.3% in patients without cirrhosis. Conclusion: With an overall 1-year relapse rate of 45% and 29% in those with a baseline serum HBV DNA 2 3 10 5 IU/mL, the APASL stopping rule for HBeAg-negative CHB patients with proper off-therapy monitoring is adequate even in patients with cirrhosis. Consolidation therapy >64 weeks seems more appropriate for those with higher baseline HBV DNA.

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“…The analysis by barrier genetic drugs showed the worst profile of persistence in low barrier agents. In this respect, Han et al 28 evaluated persistence, adherence, healthcare utilisation, and cost benefits of hepatitis B guideline recommendations. They researched into the differences in persistence, adherence and hospital stay between ‘currently recommended fist-line therapy’ and ‘not currently recommended fist-line therapy’.…”

Section: Discussionmentioning

confidence: 99%

Persistence profile to nucleos(t)ide analogue treatment for patients with chronic hepatitis B

et al. 2016

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BackgroundThere are currently five approved nucleos(t)ide analogues (NUCs) for the management of chronic hepatitis B (CHB): lamivudine, adefovir dipivoxil, telbivudine, entecavir, and tenofovir disoproxil fumarate.ObjectiveTo determine the persistence rates among patients receiving NUCs for CHB at weeks 48, 96 and 144, compare them in these periods, and analyse the evolution of treatment persistence.MethodsWe conducted a retrospective study that included patients with CHB who initiated antiviral therapy and were attended to by the pharmaceutical care office between January 2002 and December 2011. Patients included in a clinical trial or patients who did not collect their medication personally were excluded. There were two different analyses: a comparative analysis of the persistence rates in three periods (weeks 1–48, weeks 48–96, and weeks 96–144); and a Kaplan-Meier analysis to evaluate the evolution of persistence.ResultsA total of 102 patients were included. Persistence rates were different in the three periods. They decreased during the course of the different periods, and the decline was more rapid between the first and second period. There were statistically significant differences in the non-persistence of the five drugs (p<0.005). Entecavir had the best profile of persistence, followed by tenofovir.ConclusionsThis study showed that high genetic barrier drugs had a better profile of persistence in the initial treatment of patients with CHB. Data seem to suggest entecavir may offer better persistence rates than tenofovir, and the persistence rates for all five medications dropped in weeks 48–96.

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Adherence, persistence, healthcare utilization, and cost benefits of guideline-recommended hepatitis B pharmacotherapy

Cited by 12 publications

References 30 publications

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta‐Analysis

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta‐Analysis

Off-therapy durability of response to entecavir therapy in hepatitis B e antigen-negative chronic hepatitis B patients

Persistence profile to nucleos(t)ide analogue treatment for patients with chronic hepatitis B

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