Treatment of Chronic Hepatitis C in Patients Receiving Opioid Agonist Therapy

Norton, Brianna L.; Akiyama, Matthew J.; Zamor, Philippe J.; Litwin, Alain H.

doi:10.1016/j.idc.2018.02.001

Cited by 25 publications

(33 citation statements)

References 93 publications

(118 reference statements)

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“…1 Indeed, the ITT SVR12 rates with glecaprevir/pibrentasvir in this meta-analysis were uniformly high (> − 95.0%) irrespective of GT and in populations often considered more challenging to treat, such as HCV treatment-experienced patients, patients with cirrhosis, those who use illicit drugs/ OST, those with psychiatric disorders, and those taking PPIs. [36][37][38][39] The overall mITT SVR12 rate was also high in this metaanalysis (98.1%) and comparable with that observed in clinical trials (99.1%). 40 The virologic failure rate was 2.4%.…”

Section: Discussionsupporting

confidence: 85%

Real-world effectiveness and safety of glecaprevir/pibrentasvir for the treatment of patients with chronic HCV infection: A meta-analysis

Lampertico

Carrión

Curry

et al. 2020

Journal of Hepatology

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Section: Discussionsupporting

confidence: 85%

Real-world effectiveness and safety of glecaprevir/pibrentasvir for the treatment of patients with chronic HCV infection: A meta-analysis

Lampertico

Carrión

Curry

et al. 2020

Journal of Hepatology

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“…55 After the introduction of DAAs, a study found six cases of reinfection among 301 patients (4.6 reinfections per 100 person-years), with three of those experiencing spontaneous clearance of their reinfection. 56 Adherence to DAAs was associated with OAT continuity, and as such, predicted a higher adherence compared with lower level of OAT continuity in our model. Studies have shown that patients receiving higher doses of OAT, for example methadone, above 60 mg/day, have better treatment outcomes compared with lower doses 48 57 and for this reason we set high level of continuity above two DDD.…”

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

On the path towards universal coverage of hepatitis C treatment among people receiving opioid agonist therapy (OAT) in Norway: a prospective cohort study from 2013 to 2017

et al. 2020

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ObjectivesWe aimed to calculate cumulative hepatitis C virus (HCV) treatment coverage among individuals enrolled in opioid agonist therapy (OAT) in Norway between 2013 and 2017 and to document the treatment transition to direct-acting antiviral (DAA) agents. Moreover, we aimed to describe adherence to DAAs in the same cohort.DesignProspective cohort, registry data.SettingSpecialist healthcare service (secondary)Participants and outcomesThis observational study was based on data from The Norwegian Prescription Database. We studied dispensed OAT and HCV treatment annually to calculate the cumulative frequency, and employed secondary sources to calculate prevalence, incidence and HCV treatment coverage from 2013 to 2017, among the OAT population. Factors associated with adherence to DAAs were identified a priori and subject to logistic regression.Results10 371 individuals were identified with dispensed OAT, 1475 individuals of these were identified with dispensed HCV treatment. Annual HCV treatment coverage increased from 3.5% (95% CI: 3.2 to 4.4) in 2013 to 17% (95% CI: 17 to 20) in 2017, giving a cumulative HCV coverage among OAT patients in Norway of 38.5%. A complete shift to interferon-free treatment regimens occurred, where DAAs accounting for 32% of HCV treatments in 2013 and 99% in 2017. About two-thirds of OAT patients were considered adherent to their DAA regimens across all genotypes. High level of OAT continuity was associated with improved adherence to DAAs (adjusted OR 1.4, 95% CI: 1 to 2, p=0.035).ConclusionsA large increase in HCV treatment coverage attributed by a complete shift to interferon-free regimens among the Norwegian OAT population has been demonstrated. However, treatment coverage is inadmissibly too low and a further substantial scale-up in HCV treatment is required to reach the universal targets of controlling and eliminating the HCV endemic.

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“…Despite substantial increase in HCV treatment uptake in advanced health systems like Sweden and Norway, as found in our study, the treatment uptake is still too low and progress too slow globally [20,28,29]. Treatment demand has soared after the introduction of DAAs, especially among former PWIDs [11], while people who are still using drugs actively have seemingly not been fully able to benefit from the increased accessibility [11].…”

Section: Discussionmentioning

confidence: 95%

“…Addressing barriers to HCV treatment and testing are important. Between 60 and 70% of people enrolled in various opioid treatment programs are offered onsite testing for HCV [29], which is too low. OAT programs could thus benefit from introducing universal HCV testing and linkage to care in OAT settings.…”

Section: Discussionmentioning

confidence: 99%

Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017

Frode

Vold

Odsbu

et al. 2020

Subst Abuse Treat Prev Policy

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Background: Treatment with direct-acting antiviral agents (DAAs) offers an opportunity to eliminate hepatitis C virus (HCV) endemic among people who inject drugs (PWID) and people enrolled in opioid agonist therapy (OAT) programs. The objective of this study was to estimate and to compare HCV treatment uptake after the introduction of DAAs among patients receiving OAT in Sweden and Norway. We also aimed to evaluate predictors of DAAs treatment among OAT patients in both countries. Methods: This observational study was conducted with data from The Swedish Prescribed Drug Register and The Norwegian Prescription Database. We studied dispensed medications to calculate HCV treatment among OAT patients from 2014 to 2017 in Sweden and Norway. HCV prevalence was estimated from primary and secondary sources. Dispensations of medicines from different therapeutic areas, which served as proxy for co-morbidities in 2017, were conditionally adjusted for age, gender, and OAT medications. Logistic regression was used to evaluate these parameters. Results: In total 3529 individuals were identified with dispensed OAT in the Swedish cohort and 7739 individuals in the Norwegian cohort. HCV treatment was utilized by 407 persons in Sweden and 920 in Norway during the study period. Annual HCV and DAA treatment uptake increased in both countries. The estimated cumulative HCV treatment uptake at the end of 2017 was 31% in Norway and 28% in Sweden. DAA treatment was associated with increased age (aOR 1.8; 95% CI 1.0-3.2) and the dispensation of drugs used for diabetes (aOR 3.2; 95% CI 1.8-5.7) in Sweden. In Norway, lipid modifying agents and antibacterials were associated with decreased odds (aOR 0.4; 95%CI 0.2-0.9, aOR 0.8; 95%CI 0.6-1.0).

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Treatment of Chronic Hepatitis C in Patients Receiving Opioid Agonist Therapy

Cited by 25 publications

References 93 publications

Real-world effectiveness and safety of glecaprevir/pibrentasvir for the treatment of patients with chronic HCV infection: A meta-analysis

Real-world effectiveness and safety of glecaprevir/pibrentasvir for the treatment of patients with chronic HCV infection: A meta-analysis

On the path towards universal coverage of hepatitis C treatment among people receiving opioid agonist therapy (OAT) in Norway: a prospective cohort study from 2013 to 2017

Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017

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