Interferon-based hepatitis C therapy in a safety net hospital: access, efficacy, and safety

Nordstrom, Eric; Keniston, Angela; Baouchi, Fafa; Martinez‐Camacho, Alvaro

doi:10.1097/meg.0000000000000755

Cited by 12 publications

(10 citation statements)

References 28 publications

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“…Our study population suffered a loss to follow-up rate of 5%, only marginally higher than the 2.5–3.8% reported in non-indigent real-world studies [ 9 – 11 ] and comparable with the 5–15% reported in previous studies of IFN-based therapy in indigent populations [ 24 , 28 , 31 ]. Interestingly, among those lost to liver clinic follow-up, approximately 1 in 5 were subsequently seen by their primary care providers within the same healthcare system.…”

Section: Discussionsupporting

confidence: 68%

“…Of note, both prior studies were conducted in states that offer expanded Medicaid, through which access to HCV treatment is possible for a larger proportion of low-income patients. Data shows that the burden of HCV is 7.5% higher in those with Medicaid compared to commercial insurance [ 24 ]. In states without expanded Medicaid, such as Texas, access to HCV treatment is limited due to a smaller proportion of low-income patients being granted Medicaid coverage, as well as the existence of restrictions on treatment eligibility (i.e., advanced liver disease, negative toxicology screens, etc.)…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of direct-acting antiviral therapy for hepatitis C in difficult-to-treat patients in a safety-net health system: a retrospective cohort study

Yek

Flor

Marshall

et al. 2017

BMC Med

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BackgroundDirect-acting antivirals (DAAs) have revolutionized chronic hepatitis C (HCV) treatment, but real-world effectiveness among vulnerable populations, including uninsured patients, is lacking. This study was conducted to characterize the effectiveness of DAAs in a socioeconomically disadvantaged and underinsured patient cohort.MethodsThis retrospective observational study included all patients undergoing HCV treatment with DAA-based therapy between April 2014 and June 2016 at a large urban safety-net health system (Parkland Health and Hospital System, Dallas, TX, USA). The primary outcome was sustained virologic response (SVR), with secondary outcomes including treatment discontinuation, treatment relapse, and loss to follow-up.ResultsDAA-based therapy was initiated in 512 patients. The cohort was socioeconomically disadvantaged (56% uninsured and 13% Medicaid), with high historic rates of alcohol (41%) and substance (50%) use, and mental health disorders (38%). SVR was achieved in 90% of patients (n = 459); 26 patients (5%) were lost to follow-up. SVR was significantly lower in patients with decompensated cirrhosis (82% SVR; OR 0.37, 95% CI 0.16–0.85) but did not differ by insurance status (P = 0.98) or alcohol/substance use (P = 0.34). Reasons for treatment failure included loss to follow-up (n = 26, 5%), viral relapse (n = 16, 3%), non-treatment-related death (n = 7, 1%), and treatment discontinuation (n = 4, 1%). Of patients with viral relapse, 6 reported non-compliance and have not been retreated, 5 have been retreated and achieved SVR, 4 have undergone resistance testing but not yet initiated retreatment, and 1 was lost to follow-up.ConclusionsEffective outcomes with DAA-based therapy can be achieved in difficult-to-treat underinsured populations followed in resource-constrained safety-net health systems.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0969-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Effectiveness of direct-acting antiviral therapy for hepatitis C in difficult-to-treat patients in a safety-net health system: a retrospective cohort study

Yek

Flor

Marshall

et al. 2017

BMC Med

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“…The Global Burden of Disease Liver Cancer Collaboration stated that most cases of liver cancer can be prevented through various therapies, including antiviral treatment for HCC associated with viral diseases . For HCV, the recent advent of interferon (IFN)‐free direct‐acting antivirals (DAAs) has introduced highly effective (>80%‐90% cure rate) and well‐tolerated treatment, even for patients with advanced liver disease, including HCC . It has been shown to reduce HCC risk and does not increase the risk of HCC recurrence .…”

mentioning

confidence: 99%

Cure With Interferon‐Free Direct‐Acting Antiviral Is Associated With Increased Survival in Patients With Hepatitis C Virus‐Related Hepatocellular Carcinoma From Both East and West

Dang

Yeo

Yasuda³

et al. 2020

Hepatology

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BaCKgRoUND aND aIMS:Survival data among patients with hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) after achieving sustained virologic response (SVR) with interferon-free direct-acting antivirals (DAAs) in both Asian and western countries are limited. Survival rates were compared between patients with HCV-related HCC who were untreated for HCV and those who achieved SVR. appRoaCH aND ReSUltS: Using data from two U.S. and six Asian centers from 2005 to 2017, we categorized 1,676 patients who were mono-infected with HCV-related HCC into patients untreated for HCV (untreated group) and DAA-treated patients with SVR (SVR group) and matched by propensity score matching (PSM); multivariable Cox regression with HCV treatment status as a time-varying covariate was used to determine mortality risk and landmark analysis to avoid immortal time bias. There were 1,239 untreated patients and 437 patients with SVR. After PSM, background risks of the 321 pairs of matched patients were balanced (all P > 0.05). After time-varying adjustment for HCV treatment initiation compared with untreated patients, patients with SVR had significantly higher 5-year overall survival (87.78% vs. 66.05%, P < 0.001). Multivariable Cox regression showed that SVR was independently associated with a 63% lower risk of 5-year all-cause mortality (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.16-0.83; P = 0.016) and 66% lower risk of 5-year liver-related mortality (HR, 0.34; 95% CI, 0.13-0.88; P = 0.026) with similar trends after removing patients with liver transplants. Landmark analysis at 90, 180, and 360 days showed consistent results (HRs ranged 0.22 to 0.44, all P < 0.05). CoNClUSIoN:In this multinational consortium, patients with HCV-related HCC who obtained SVR achieved a 60%-70% improvement in 5-year survival (both all-cause and liver related) compared with patients untreated for HCV. Patients eligible for HCC therapy should also be considered for DAA therapy.

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“…Several clinical variables that may explain different response to antiviral treatment among patients with HCV infection have been suggested. 18-21 By univariate and multivariate analyses, we found no relationship between patients’ baseline characteristics and SVR rates. These data provide further evidence that baseline characteristics (such as HCV genotype, sex, fibrosis status, HIV coinfection, prior treatment failure, and HCV RNA) have less impact on SVR rates with DAA-based antiviral therapy.…”

Section: Discussionmentioning

confidence: 69%

Effect of Health Insurance on Hepatitis C Sustained Virologic Response Rates to Sofosbuvir-Based Treatment Regimens in a South Florida Community Hospital

Eckardt

Niu

Savage

et al. 2019

J Int Assoc Provid AIDS Care

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The high cost of direct-acting antiviral–based regimens raises concerns about the outcome of treatment in uninsured patients with chronic hepatitis C virus (HCV) infection. This study assessed the relationship between health insurance status and sustained virologic response (SVR) rates in a community hospital in South Florida. Sofosbuvir-based therapy was initiated in 82 patients, of which 73% were uninsured and 28 (34%) were HIV coinfection. The overall SVR rate for those tested was 98%. The SVR rates were similar between HCV mono- and HCV/HIV coinfected patients (96% versus 100%, P = .204). Uninsured patients, with access to patient assistance programs, had comparable SVR rates to insured patients (100% versus 95%, P = .131). However, there was a trend toward a higher rate of loss to follow-up in uninsured compared to insured patients (25% versus 9%, P = .116). Strategies specific to adherence to treatment for uninsured patients are needed to reduce rates of loss to follow-up.

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Interferon-based hepatitis C therapy in a safety net hospital: access, efficacy, and safety

Abstract: An acceptable SVR rate is achievable in a safety net patient population. Addressing the barriers to care will be paramount when using direct-acting antivirals.

Cited by 12 publications

References 28 publications

Effectiveness of direct-acting antiviral therapy for hepatitis C in difficult-to-treat patients in a safety-net health system: a retrospective cohort study

Effectiveness of direct-acting antiviral therapy for hepatitis C in difficult-to-treat patients in a safety-net health system: a retrospective cohort study

Cure With Interferon‐Free Direct‐Acting Antiviral Is Associated With Increased Survival in Patients With Hepatitis C Virus‐Related Hepatocellular Carcinoma From Both East and West

Effect of Health Insurance on Hepatitis C Sustained Virologic Response Rates to Sofosbuvir-Based Treatment Regimens in a South Florida Community Hospital

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