The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver

Shah, Hemant; Bilodeau, Marc; Burak, Kelly W.; Cooper, Curtis; Klein, Marina B.; Ramji, Alnoor; Smyth, Dan; Feld, Jordan J.

doi:10.1503/cmaj.170453

Cited by 97 publications

(105 citation statements)

References 83 publications

(74 reference statements)

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“…Similar to previous reports, the GT3 SVR rate for SOF + RBV was sub‐optimal . Currently, newer DAA regimens such as sofosbuvir plus daclatasvir or velpatasvir‐based regimens or glecaprevir/pibrentasvir are the recommended GT3 therapies …”

Section: Discussionsupporting

confidence: 79%

“…[41][42][43] Currently, newer DAA regimens such as sofosbuvir plus daclatasvir or velpatasvir-based regimens or glecaprevir/ pibrentasvir are the recommended GT3 therapies. 33,40,41 Although, it has been shown that IDU and OST could significantly reduce the SVR, 44 in our study these factors were not associated with treatment effectiveness. In a recent study, it has been shown that reinfection rate is higher among recent IDU compared to past IDU.…”

Section: Yescontrasting

confidence: 68%

“…However, only 28% of treated individuals had 8 weeks treatment duration. Hence, as reported by similar studies, it is likely that a considerable proportion of patients who received LDV/SOF ± RBV regimens were over‐treated . Among patients with cirrhosis, although over 96% had treatment duration of 12 or 24 weeks, the SVR rate was still significantly lower than for noncirrhotic patients (91.8% vs 95.4%).…”

Section: Discussionmentioning

confidence: 83%

“…Among patients with cirrhosis, although over 96% had treatment duration of 12 or 24 weeks, the SVR rate was still significantly lower than for noncirrhotic patients (91.8% vs 95.4%). This finding might be explained by the fact that despite the recommendations, only 4.2% (17/403) of patients with cirrhosis received RBV combination therapy and 52.8% had treatment duration of 24 weeks.…”

Section: Discussionmentioning

confidence: 98%

“…Additionally, the majority were treatment naïve (76.7%), and the HCV viral load among all individuals was below 6 million IU/mL. Based on treatment recommendations and the above mentioned criteria, 8 weeks treatment duration could have been selected for many patients. However, only 28% of treated individuals had 8 weeks treatment duration.…”

Section: Discussionmentioning

confidence: 99%

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Loss to follow‐up: A significant barrier in the treatment cascade with direct‐acting therapies

Darvishian

Wong

Binka

et al. 2019

Journal of Viral Hepatitis

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Effectiveness of direct‐acting antiviral (DAA) therapies could be influenced by patient characteristics such as comorbid conditions, which could lead to premature treatment discontinuation and/or irregular medical follow‐ups. Here, we evaluate loss to follow‐up and treatment effectiveness of sofosbuvir/ledipasvir ± ribavirin (SOF/LDV ± RBV), ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin (OBV/PTV/r + DSV ± RBV) for hepatitis C virus (HCV) genotype 1 (GT1) and sofosbuvir + ribavirin (SOF + RBV) for genotype 3 (GT3) in British Columbia Canada: The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV since 1992, integrated with medical visit, hospitalization and prescription drug data. HCV‐positive individuals who initiated DAA regimens, irrespective of treatment completion, for GT1 and GT3 until 31 December, 2017 were included. Factors associated with sustained virological response (SVR) and loss to follow‐up were assessed by using multivariable logistic regression models. In total 4477 individuals initiated DAAs. The most common prescribed DAA was SOF/LDV ± RBV with SVR of 95%. The highest SVR of 99.5% was observed among OBV/PTV/r + DSV‐treated patients. Overall, 453 (10.1%) individuals were lost to follow‐up. Higher loss to follow‐up was observed among GT1 patients treated with OBV (17.8%) and GT3 patients (15.7%). The loss to follow‐up rate was significantly higher among individuals aged <60 years, those with a history of injection drug use (IDU), on opioid substitution therapy and with cirrhosis. Our findings indicate that loss to follow‐up exceeds viral failure in HCV DAA therapy and its rate varies significantly by genotype and treatment regimen. Depending on the aetiology of lost to follow‐up, personalized case management for those with medical complications and supporting services among IDU are needed to achieve the full benefits of effective treatments.

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Section: Discussionsupporting

confidence: 79%