TY - JOUR
T1 - Long-term benefit of hepatitis C therapy in a safety net hospital system
T2 - A cross-sectional study with median 5-year follow-up
AU - Singal, Amit G.
AU - Dharia, Tushar D.
AU - Malet, Peter F.
AU - Alqahtani, Saleh
AU - Zhang, Song
AU - Cuthbert, Jennifer A.
PY - 2013
Y1 - 2013
N2 - Objectives: To demonstrate the survival benefit from sustained virological response (SVR) in a safety net hospital population with limited resources for hepatitis C virus (HCV) therapy. Design and setting: We conducted a retrospective study at an urban safety net hospital in the USA. Participants and intervention: 242 patients receiving standard HCV therapy between 2001 and 2006. Primary and secondary outcome measures: Response rates, including SVR, were recorded for each patient. Univariate and multivariate analyses were performed to identify predictors of SVR and 5-year survival. Results: A total of 242 eligible patients were treated. Treatment was completed in 197 (81%) patients, with 43 patients discontinuing therapy early-32 due to adverse events and 11 due to non-compliance. Complications on treatment were frequent, including three deaths. SVR was achieved in 83 patients (34%). On multivariate analysis, independent predictors of a decreased likelihood of achieving SVR included African-American race (OR 0.20, 95% CI 0.07 to 0.54), genotype 1 HCV infection (OR 0.25, 95% CI 0.13 to 0.50) and the presence of cirrhosis (OR 0.26, 95% CI 0.12 to 0.58). Survival was 98% in those achieving SVR (median follow-up 72 months) and 71 % in non-responders and those discontinuing therapy (n=91, median known follow-up 65 and 36 months, respectively). On multivariate analysis, the only independent predictor of improved survival was SVR (HR 0.12, 95% CI 0.03 to 0.52). Both cirrhosis and hypoalbuminaemia were independent predictors of increased mortality. Conclusions: Treatment before histological cirrhosis develops, in combination with careful selection, may improve long-term outcomes without compromising other healthcare endeavours in safety net hospitals and areas with financial limitations.
AB - Objectives: To demonstrate the survival benefit from sustained virological response (SVR) in a safety net hospital population with limited resources for hepatitis C virus (HCV) therapy. Design and setting: We conducted a retrospective study at an urban safety net hospital in the USA. Participants and intervention: 242 patients receiving standard HCV therapy between 2001 and 2006. Primary and secondary outcome measures: Response rates, including SVR, were recorded for each patient. Univariate and multivariate analyses were performed to identify predictors of SVR and 5-year survival. Results: A total of 242 eligible patients were treated. Treatment was completed in 197 (81%) patients, with 43 patients discontinuing therapy early-32 due to adverse events and 11 due to non-compliance. Complications on treatment were frequent, including three deaths. SVR was achieved in 83 patients (34%). On multivariate analysis, independent predictors of a decreased likelihood of achieving SVR included African-American race (OR 0.20, 95% CI 0.07 to 0.54), genotype 1 HCV infection (OR 0.25, 95% CI 0.13 to 0.50) and the presence of cirrhosis (OR 0.26, 95% CI 0.12 to 0.58). Survival was 98% in those achieving SVR (median follow-up 72 months) and 71 % in non-responders and those discontinuing therapy (n=91, median known follow-up 65 and 36 months, respectively). On multivariate analysis, the only independent predictor of improved survival was SVR (HR 0.12, 95% CI 0.03 to 0.52). Both cirrhosis and hypoalbuminaemia were independent predictors of increased mortality. Conclusions: Treatment before histological cirrhosis develops, in combination with careful selection, may improve long-term outcomes without compromising other healthcare endeavours in safety net hospitals and areas with financial limitations.
UR - http://www.scopus.com/inward/record.url?scp=84885349052&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84885349052&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2013-003231
DO - 10.1136/bmjopen-2013-003231
M3 - Article
C2 - 24002983
AN - SCOPUS:84885349052
SN - 2044-6055
VL - 3
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e003231
ER -