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

Autor: Angela Keniston, Eric M. Nordstrom, Fafa Baouchi, Alvaro Martinez-Camacho
Rok vydání: 2016
Předmět:
Male
Time Factors
Sustained Virologic Response
Hepacivirus
Health Services Accessibility
Polyethylene Glycols
chemistry.chemical_compound
0302 clinical medicine
Pegylated interferon
Risk Factors
Odds Ratio
030212 general & internal medicine
Gastroenterology
Hepatitis C
Middle Aged
Viral Load
Recombinant Proteins
Treatment Outcome
RNA
Viral
030211 gastroenterology & hepatology
Drug Therapy
Combination
Female
Viral load
medicine.drug
Adult
medicine.medical_specialty
Colorado
Genotype
Interferon alpha-2
Antiviral Agents
03 medical and health sciences
Pharmacotherapy
Internal medicine
Ribavirin
medicine
Humans
Intensive care medicine
Rapid Virologic Response
Retrospective Studies
Chi-Square Distribution
Hepatology
business.industry
Interferon-alpha
Odds ratio
Hepatitis C Antibodies
medicine.disease
Discontinuation
Logistic Models
chemistry
Socioeconomic Factors
Multivariate Analysis
business
Safety-net Providers
Zdroj: European journal of gastroenterologyhepatology. 29(1)
ISSN: 1473-5687
Popis: Aims This study assesses the efficacy, accessibility, and safety of hepatitis C virus (HCV) treatment in a safety net hospital population. Methods Patients at Denver Health receiving pegylated interferon for HCV infection between 2008 and 2012 were included in this retrospective study. Sociodemographic, biochemical, and virologic data were collected on each patient. The primary outcomes were the rate of sustained virologic response and early treatment discontinuation, with reason for discontinuation documented. Multivariable analyses were performed to identify factors associated with the primary outcomes. Results Detectable HCV antibodies were found in 2912 patients, and 1630 had a detectable viral load. Eighty percent of these patients were uninsured/underinsured. Only 46% were seen in the hepatology clinic, and 8% received interferon-based HCV treatment. Of the 125 patients treated with interferon-containing regimens, 54% had genotype 1 infection. The overall rate of sustained virologic response (SVR) was 47%. Rapid virologic response, low FIB-4 score combined with age, and increasing number of days on therapy were associated with SVR in multivariable analysis. Therapy was prematurely discontinued in 43% of patients related to being lost to follow-up (30%), null response (24%), and intolerance to pegylated interferon/ribavirin (24%). Genotype 1 infection and unfavorable viral kinetics were associated with premature treatment discontinuation in multivariable analysis. There were no statistically significant associations between age, sex, ethnicity, race, diabetes, BMI, psychiatric comorbidities, income, employment status, homelessness, or insurance status and the primary outcomes. Conclusion 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.
Databáze: OpenAIRE
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