Document Detail


Absolute and relative contraindications to pegylated-interferon or ribavirin in the US general patient population with chronic hepatitis C: results from a US database of over 45 000 HCV-infected, evaluated patients.
MedLine Citation:
PMID:  23289640     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Chronic hepatitis C (HCV) treatment with pegylated-interferon (PEG-IFN)/ribavirin (RBV) is often limited by preexisting medical, psychiatric and psychosocial contraindications. However, limited data exist in general patient populations.
AIM: To evaluate the percentage of HCV-infected patients in the general US population who may have contraindications to PEG-IFN/RBV.
METHODS: The General Electric (GE) Centricity dataset was used to screen the US population between 2004 and 2009 for HCV infection and contraindications to PEG-IFN/RBV. HCV diagnosis and contraindications were identified using ICD-9-CM codes or laboratory values. Only patients with an encounter 180 days prior to HCV diagnosis were included. Demographic differences were calculated using Pearson's chi-squared test. Frequencies and percentages for absolute and relative contraindications to PEG-IFN and/or RBV were determined and proportions and rates/1000 person-months were calculated.
RESULTS: A total of 15 561 021 patients were screened, and 45 690 (0.3%) were HCV-positive and were evaluated. Those with contraindications were significantly younger, female, White, not currently married and receiving Medicare or Medicaid coverage (all P < 0.0001). 17.3% had at least one contraindication to PEG-IFN/RBV (5.5 events/1000 person-months); bipolar disorder (6.5%), anaemia (Hgb < 10 g/dL; 5.9%), pregnancy (1.9%) and neutropenia (neutrophils <750 cells/mm(3) ; 1.2%) were most frequently cited.
CONCLUSIONS: Approximately, 17% of HCV-infected patients in the general US population had at least one contraindication to PEG-IFN/RBV. Most contraindications were relative and potentially modifiable. Clinical assessment of contraindications as relative and/or modifiable should be considered and used to determine if patients could benefit from current PEG-IFN-containing triple therapy or future PEG-IFN- or RBV-free regimens.
Authors:
A H Talal; J LaFleur; R Hoop; P Pandya; P Martin; I Jacobson; J Han; E J Korner
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-01-07
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  37     ISSN:  1365-2036     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-22     Completed Date:  2013-06-26     Revised Date:  2013-10-01    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  473-81     Citation Subset:  IM    
Copyright Information:
© 2013 Blackwell Publishing Ltd.
Affiliation:
State University of New York, Buffalo, NY 14203, USA. ahtalal@buffalo.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Antiviral Agents / contraindications*,  therapeutic use
Child
Child, Preschool
Databases, Factual
Drug Therapy, Combination
Female
Hepatitis C, Chronic / drug therapy*
Humans
Infant
Interferon-alpha / contraindications*,  therapeutic use
Male
Middle Aged
Polyethylene Glycols / contraindications*,  therapeutic use
Recombinant Proteins / contraindications,  therapeutic use
Ribavirin / contraindications*,  therapeutic use
Treatment Outcome
United States
Young Adult
Chemical
Reg. No./Substance:
0/Antiviral Agents; 0/Interferon-alpha; 0/Polyethylene Glycols; 0/Recombinant Proteins; 0/peginterferon alfa-2a; 0/peginterferon alfa-2b; 36791-04-5/Ribavirin
Comments/Corrections
Comment In:
Aliment Pharmacol Ther. 2013 Sep;38(5):553-4   [PMID:  23937462 ]
Aliment Pharmacol Ther. 2013 Sep;38(5):554-5   [PMID:  23937463 ]

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