Huge Gap Between Clinical Efficacy and Community Effectiveness in the Treatment of Chronic Hepatitis C

Yu, Ming‐Lung; Yeh, Ming‐Lun; Tsai, Pei‐Chien; Huang, Ching‐I; Huang, Jee‐Fu; Huang, Chung‐Feng; Hsieh, Meng‐Hsuan; Liang, Po‐Cheng; Lin, Yi‐Hung; Hsieh, Ming‐Yen; Lin, Wen‐Yi; Hou, Nai‐Jen; Lin, Zu‐Yau; Chen, Shinn‐Cherng; Dai, Chia‐Yen; Chuang, Wan‐Long; Chang, Wen‐Yu

doi:10.1097/md.0000000000000690

Cited by 96 publications

(117 citation statements)

References 52 publications

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“…Taiwan is an endemic country with a seroprevalence ranging from 3.3% to 4.4% [30–34]. Of particular note is that the prevalence of HCV infection prevails in certain areas [32] and populations [19,35,36].…”

Section: Discussionmentioning

confidence: 99%

Seroprevalence and clinical characteristics of viral hepatitis in transfusion-dependent thalassemia and hemophilia patients

et al. 2017

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Background/AimsTransfusion dependent subjects are at a great risk of viral hepatitis infection. We aimed to evaluate the prevalence and factors associated with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among transfusion-dependent patients in Taiwan.MethodsA total of 140 patients (67 thalassemic patients, 70 hemophilic patients, two patients with hereditary spherocytosis and one patient with von Willebrand disease) were prospectively enrolled to evaluate the prevalence and factors associated with viral hepatitis and spontaneous HCV clearance. All patients were tested for HBV and HCV serology and virology. Two consecutive serum samples, at least 1 year apart, were collected to clarify HCV seroclearance.ResultsThe seropositivity rate of hepatitis B surface antigen (HBsAg), HCV antibody (anti-HCV), and both HBsAg/anti-HCV were 6.4%, 45.7% and 5%, respectively. Logistic regression analysis of factors associated with anti-HCV seropositivity included age (odds ratio/95% confidence interval [OR/CI]: 1.12/1.07–1.18, P<0.001), serum alanine aminotransferase (ALT) (OR/CI: 1.04/1.02–1.06, P<0.001) and platelet counts (OR/CI: 0.995/0.991–0.998, P = 0.002). Age was the only factor independently associated with HBsAg seropositivity (OR/CI: 1.08/1.02–1.14.4, P = 0.007). Compared to patients born before 1992, the seroprevalence of HCV among thalassemic patients decreased dramatically in those born after 1992 (46.0% vs. 11.8%, p = 0.012). The seroprevalence of HCV among hemophilic patients also decreased significantly when comparing patients born before 1987 to those born after 1987 (79.5% vs. 11.5%, p<0.001). Similarly, the seroprevalence of HBV decreased significantly in the post-vaccination cohort compared to its counterpart (13.1%, vs. 1.3%, p = 0.005). The spontaneous clearance of HCV was observed in 25.4% (15/59) of patients, and ALT was the only factor associated with it (OR/CI 0.98/0.96–1.00, P = 0.02).ConclusionsBoth HBV and HCV infections are prevalent among transfusion-dependent thalassemic and hemophilic patients in Taiwan. Nevertheless, seroprevalence decreased significantly and dramatically for HCV after universal blood screening and for HBV after implementation of a universal mass vaccination program.

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Section: Discussionmentioning

confidence: 99%

Seroprevalence and clinical characteristics of viral hepatitis in transfusion-dependent thalassemia and hemophilia patients

et al. 2017

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“…A recent U.S. study including 101,444 Veterans showed that treatment initiation rate was very low (7.4%), and those with genotype 2/3, non-white race, and Medicare or other insurances were correlated with high treatment initiation rates 13. In a recent Taiwan study, the treatment rate was 13.7% in the estimated HCV-viremic population of 554,361 8. The treatment initiation rate reported in this study was much higher than in previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…According to previous studies, the sustained virologic response (SVR) rate of pegylated interferon (pegIFN) plus ribavirin (RBV) therapy is higher in Asian HCV patients compared to that of Caucasian HCV patients 4–6. Nevertheless, actual treatment initiation rates were documented to be as low as less than 10% in many countries 7,8…”

Section: Introductionmentioning

confidence: 99%

Final Report of Unmet Needs of Interferon-Based Therapy for Chronic Hepatitis C in Korea: Basis for Moving into the Direct-Acting Antiviral Era

Jang

Kim

et al. 2017

Gut and Liver

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Background/AimsTo evaluate the era of direct acting antivirals (DAAs), we must understand the treatment patterns and outcomes of interferon-based therapy for hepatitis C virus (HCV) infection. We aimed to elucidate the treatment rate, factors affecting treatment decisions, and efficacy of interferon-based therapy in a real-world setting.MethodsThis nationwide cohort study included 1,191 newly diagnosed patients with chronic HCV infection at seven tertiary hospitals in South Korea. Subjects were followed retrospectively until March 2015, which was just before the approval of DAA therapy.ResultsIn total, 48.2% and 49.3% of the patients had HCV genotypes 1 and 2, respectively. Interferon-based therapy was initiated in 541 patients (45.4%). The major reasons for no treatment included ineligibility (18.9%), concern about adverse events (22.3%), cost (21.5%), and an age >75 years (19.5%). Interferon-based therapy was discontinued (18.5%) mainly due to adverse events (n=66). The intent-to-treat analysis found that the sustained virologic response (SVR) rate was 58.3% in genotype 1 patients and 74.7% in non-genotype 1 patients.ConclusionsApproximately one-third of newly diagnosed HCV patients in South Korea received interferon-based therapy and showed a suboptimal SVR rate. Diagnosis of patients at younger ages and with a less advanced liver status and reducing the DAA therapy cost may fulfill unmet needs.

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“…In recent years, HCV treatment options have developed rapidly from peginterferon alfa plus ribavirin (RBV) to all‐oral combinations of direct‐acting antivirals (DAAs) . Peginterferon‐α/RBV has significant contraindications, including hematologic and psychiatric comorbidities, that restrict treatment eligibility and uptake, but despite the superior outcomes and tolerability of DAA‐based regimens all‐oral treatment is not yet available in all countries …”

Section: Introductionmentioning

confidence: 99%

Daclatasvir/asunaprevir/beclabuvir, all‐oral, fixed‐dose combination for patients with chronic hepatitis C virus genotype 1

Kao

Peng

et al. 2017

J of Gastro and Hepatol

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Huge Gap Between Clinical Efficacy and Community Effectiveness in the Treatment of Chronic Hepatitis C

Abstract: Supplemental Digital Content is available in the text

Cited by 96 publications

References 52 publications

Seroprevalence and clinical characteristics of viral hepatitis in transfusion-dependent thalassemia and hemophilia patients

Seroprevalence and clinical characteristics of viral hepatitis in transfusion-dependent thalassemia and hemophilia patients

Final Report of Unmet Needs of Interferon-Based Therapy for Chronic Hepatitis C in Korea: Basis for Moving into the Direct-Acting Antiviral Era

Daclatasvir/asunaprevir/beclabuvir, all‐oral, fixed‐dose combination for patients with chronic hepatitis C virus genotype 1

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