Thursday, February 12, 2015

Patient-reported outcomes in chronic hepatitis C - the impact of liver disease and new treatment regimens

Alimentary Pharmacology & Therapeutics
Volume 41, Issue 6, pages 497–520, March 2015

Patient-reported outcomes in chronic hepatitis C
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 March's Alimentary Pharmacology & Therapeutics investigates patient-reported outcomes in chronic hepatitis C, the impact of liver disease, and new treatment regimens.

Treatment for chronic hepatitis C is rapidly changing and moving away from an interferon and ribavirin-based therapy to interferon-free ribavirin-free all oral regimens.

These regimens are simpler and shorter to administer with very high efficacy rates and better side effect profiles.

As advances in the treatment of chronic hepatitis C occur, it is imperative to capture both clinical outcomes as well as patient-reported outcomes.

In fact, patient-reported outcome assesses and quantifies the impact of these regimens on patient experience.

PROs assess patients' health-related quality of life (HRQOL) especially in the realms of fatigue and neuropsychiatric issues such as depression which can affect treatment adherence and work productivity.

Drs Younossi and Henry from France reviewed the literature related to patient-reported outcomes in HCV patients, and summarized the impact of chronic hepatitis C, and its treatment on patient-reported outcomes.

Databases Ovid MEDLINE and PubMed were searched from 1990 to 2014 using a combination of MEsh, thesaurus terms and relevant text words.

The text words included hepatitis C, chronic hepatitis C, treatment, quality of life, health-related quality of life, fatigue, work productivity, adherence, patient-reported outcomes, direct acting anti-viral agents and second generation direct acting anti-viral agents.

Each manuscript was assessed for pertinence to the issue of patient-reported outcomes in chronic hepatitis C as well as the quality of study design and publications.

The researchers found that chronic hepatitis C patients have baseline patient-reported outcome impairment.

Furthermore, treatment with interferon with or without ribavirin and first generation DAAs causes additional patient-reported outcome burden which can negatively impact treatment adherence and indirectly, treatment efficacy and work productivity.

The team noted that new treatment regimens with interferon- and ribavirin-free regimens not only have very high efficacy, but also result in the improvement of patient-reported outcome scores as early as 2 weeks into treatment as well as possibly better adherence to treatment regimens.

Dr Younossi and colleague commented, "Chronic hepatitis C and its treatment have been associated with patient-reported outcome impairment."

"The new IF-free and RBV-free regimens are associated with high efficacy and substantial improvement of patient-reported outcomes in clinical trial setting."

"Although very encouraging, more data are needed to assess patient-reported outcomes, adherence and work productivity of chronic hepatitis C patients in the real world setting of clinical practice.

Full text available @ Alimentary Pharmacology & TherapeuticsSystematic review: patient-reported outcomes in chronic hepatitis C - the impact of liver disease and new treatment regimens

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