Treatment of hepatitis C with direct-acting antivirals significantly reduces liver-related hospitalizations in patients with cirrhosis

Hill, Lucas; Delmonte, Ronnie J; Andrews, Barbara; Richards, Lisa; Soto, R; Collier, Summer; Kuo, Alexander

doi:10.1097/meg.0000000000001195

Cited by 15 publications

(19 citation statements)

References 28 publications

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“…However, they remained largely stable across countries during this period, contrary to modelling studies that have forecasted an increasing burden of liver cirrhosis and other chronic liver diseases [7,16] as well as liver cirrhosis attributable to HCV until 2030 [21,22]. This discrepancy may be due to general improvements in the medical care of patients with cirrhosis over the reporting period, and later on through the impact of direct-acting antivirals (DAA) programmes for HCV patients which have been rolled out in the region and found to be effective in significantly reducing hospitalisations in cirrhotic patients with HCV infection [23]. Liver transplants for which cirrhotic patients would have been hospitalised, have also been stagnant during the reporting period of this study owing to donor shortages [24].…”

Section: Discussionmentioning

confidence: 99%

Hospital discharges of hepatocellular carcinoma and non-alcohol related cirrhosis in the EU/EEA and United Kingdom: a descriptive analysis of 2004–2015 data

Nakitanda

Duffell

2020

Infectious Diseases

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Background: Viral hepatitis is a leading cause of mortality globally, comparable to that of HIV and TB. Most hepatitis deaths are related to liver cirrhosis and hepatocellular carcinoma (HCC) associated with chronic hepatitis B and C infections. To examine the progress towards the elimination goals set in the global health sector strategy for viral hepatitis, we aimed to assess the impact of mortality-indicative morbidity. Methods: We retrieved inpatients and day cases hospital discharges data from the Eurostat hospital activities database, and analysed ICD-10 and ICD-9 specific codes related to primary HCC and non-alcohol related cirrhosis registered by European Union/European Economic Area (EU/EEA) countries and United Kingdom (UK) for 2004 to 2015. Results: In 2015, 20 countries (45.7% of total EU/EEA/UK population) reported 13,236 (Range 0-6294) day cases and 36,012 (4-9097) inpatients discharges of HCC. Romania, Croatia, Luxembourg and UK reported increasing day cases discharge rates between 2004 and 2015; while HCC inpatients discharge rates increased overall during this period. There were 13,865 (0-5918) day cases and 56,176 (3-29,118) inpatients discharges reported for cirrhosis across the 20 countries in 2015. Over the 12 years, day cases discharge rates for cirrhosis increased in Romania, Croatia and UK. Though higher than for day cases, cirrhosis inpatients discharge rates remained stable. Conclusions: The hospital burden of HCC and cirrhosis is high, with considerable inpatient load including sustained increasing trends in HCC discharge rates. Further interpretation in light of local health system contexts, and more robust harmonised data are needed to better understand the impact of the viral hepatitis epidemic in the region. KEYWORDS Hepatocellular carcinoma non-alcohol related liver cirrhosis day cases discharges inpatients discharges hepatitis B virus hepatitis C virus ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Hospital discharges of hepatocellular carcinoma and non-alcohol related cirrhosis in the EU/EEA and United Kingdom: a descriptive analysis of 2004–2015 data

Nakitanda

Duffell

2020

Infectious Diseases

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“…Quality Assessment. SYRCLE's risk of bias tool for animal studies [23] was used for evaluations, including (1) whether the allocation sequence was adequately generated and applied, (2) whether the baselines are identical, (3) whether the allocation adequately concealed, (4) whether the animals were randomized during the experiment, (5) whether the researchers were blinded, (6) whether the animals were selected at random for outcome assessment, (7) whether the result evaluators were blinded, (8) whether incomplete data were reported, (9) whether the research report was irrelevant to the selective results report, and (10) whether there were no other biases. "Yes," "no," and "uncertainty" represent low bias risk, high bias risk, and uncertain bias risk, respectively.…”

Section: Study Selection and Data Extractionmentioning

confidence: 99%

“…Cirrhosis causes approximately 1 million deaths per year [1]. e treatment costs associated with gastrointestinal bleeding, ascites, and other complications are more than three times higher for patients with cirrhosis than for those without cirrhosis [2]. e global burden of liver fibrosis is increasing [3], and drugs to improve liver fibrosis will bring huge benefits.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Effect of Tanshinone IIA on Liver Fibrosis and the Possible Mechanism: A Preclinical Meta-Analysis

Ying

Teng

Zhang

et al. 2019

Evidence-Based Complementary and Alternative Medicine

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Background. Liver fibrosis is a serious human health problem, and there is a need for specific antifibrosis drugs in the clinic. Tanshinone IIA has recently been reported to have a role in the treatment of liver fibrosis. However, the evidence supporting its antifibrotic effect is not sufficient, and the underlying mechanism is not clear. We thus performed this meta-analysis of animal research to assess the therapeutic effect of tanshinone IIA on liver fibrosis and analyzed the possible associated mechanism to provide a reference for further clinical drug preparation and clinical research. Methods. We collect related articles from the databases PubMed, Web of Science, Embase, Wanfang, VIP, and CNKI. The quality of the included studies was evaluated according to the SYRCLE risk of bias tool for animal studies. Data were analyzed using RavMan 5.3 and Stata 12.0 software. Results. A total of 404 articles were retrieved from the databases. After screening, 11 articles were included in the analysis. The included studies’ methodological quality was generally low, and an obvious publication bias was found. The results showed that tanshinone IIA significantly improved liver function in experimental animals and reduced the level of liver fibrosis by reducing inflammation and inhibiting immunity, antiapoptotic processes, and HSC activation. Conclusion. Tanshinone IIA can effectively improve liver fibrosis and liver function in animal models and is worthy of future higher quality animal studies and clinical drug trials.

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“…9 Patients treated with DAAs who achieve SVR have reduced mortality, need for liver transplantation, hepatocellular carcinoma risk, liver-related hospitalizations, and health care costs. 10-14 Risk factors for treatment failure have been described and include advanced liver disease, HCV genotype, hepatocellular carcinoma, and previous DAA treatment failure especially if resistance-associated substitutions are present. 15-21 Failure to achieve SVR has detrimental downstream effects on both clinical outcomes and overall cost of therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, hospitalized patients may experience changes that alter pharmacokinetic elimination and metabolism, with variations in renal and/or hepatic function. A recent study revealed that only 74% of patients with cirrhosis hospitalized for liver-related complications after DAA treatment achieved SVR 13 ; it is important to answer the question if hospitalization during DAA treatment affects or otherwise acts as a prognostic indicator of SVR failure. In addition, identifying patients at risk for hospitalization during treatment may be important to ensure that hospitalized patients have appropriate supply of their DAA regimen during admission.…”

Section: Introductionmentioning

confidence: 99%

Sustained Virologic Response of Patients Hospitalized Compared With Those Not Hospitalized During Treatment for Hepatitis C Virus With Direct-Acting Antivirals

Gentene

Bell

Pence³

et al. 2020

Ann Pharmacother

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Background: Direct-acting antivirals (DAAs) for treatment of hepatitis C virus (HCV) have resulted in great success through high attainment of sustained virologic response (SVR). Risk factors for DAA treatment failure are important to identify because of worsened outcomes with failure and high treatment cost. Objective: We sought to identify whether hospitalization during treatment affects SVR. The primary outcome was the difference in SVR at 12 weeks after treatment Methods: This multicenter, single health system retrospective cohort review compared achievement of SVR between patients hospitalized during DAA treatment for HCV with those not hospitalized during treatment. Results: Patients in the hospitalized cohort (n = 94) had more severe disease at baseline than nonhospitalized patients (n = 167) as indicated through higher Model for End-Stage Liver Disease (MELD) scores, Fibrosis-4 scores, and imaging-suggested or biopsy-confirmed cirrhosis. Patients hospitalized during treatment had lower SVR rates compared with those not hospitalized (87.2% vs 95.2%; P = 0.043) but failed to reach significance when inpatient mortality was excluded on secondary analysis (91.1% vs 95.2%; P = 0.195). Patients who were hospitalized and did not achieve SVR had higher MELD scores, were more likely to have intensive care unit stay, and had longer hospital stay compared with those who achieved SVR. Of 94 patients, 93 provided home supply of DAAs during hospitalization. Conclusion and Relevance: Patients hospitalized during DAA treatment for HCV had reduced rates of SVR. This reduced SVR rate may be driven by inpatient mortality and severity of liver disease. Patient education to bring home supply of medication for use during admission is an effective intervention.

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Treatment of hepatitis C with direct-acting antivirals significantly reduces liver-related hospitalizations in patients with cirrhosis

Abstract: Successful DAA treatment reduces hospitalization rate and resource utilization costs in patients with CTP-A and CTP-B, but not in those with CTP-C.

Cited by 15 publications

References 28 publications

Hospital discharges of hepatocellular carcinoma and non-alcohol related cirrhosis in the EU/EEA and United Kingdom: a descriptive analysis of 2004–2015 data

Hospital discharges of hepatocellular carcinoma and non-alcohol related cirrhosis in the EU/EEA and United Kingdom: a descriptive analysis of 2004–2015 data

Therapeutic Effect of Tanshinone IIA on Liver Fibrosis and the Possible Mechanism: A Preclinical Meta-Analysis

Sustained Virologic Response of Patients Hospitalized Compared With Those Not Hospitalized During Treatment for Hepatitis C Virus With Direct-Acting Antivirals

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