Predictors of Early Treatment Discontinuation Among Patients with Genotype 1 Hepatitis C and Implications for Viral Eradication.

Clin Gastroenterol Hepatol. 2010 Aug 5. [Epub ahead of print]

Beste LA, Ioannou GN, Larson M, Chapko M, Dominitz JA.

Health Services Research and Development Center of Excellence, VA Puget Sound Healthcare System, Seattle WA; Northwest Hepatitis C Resource Center, VA Puget Sound Healthcare System, Seattle WA; Division of General Internal Medicine, VA Puget Sound Healthcare System.

Abstract

BACKGROUND & AIMS: A significant proportion of patients with hepatitis C virus (HCV) infection discontinue antiviral treatment prematurely. Risk factors for discontinuation before 48 weeks among patients with genotype 1 HCV vary over the course of therapy. We investigated the rates and risk factors for treatment discontinuation within 12 weeks, 12-24 weeks, and 24-48 weeks after therapy began. METHODS: We retrospectively evaluated data from all Veterans Affairs (VA) patients with genotype 1 HCV who initiated pegylated interferon and ribavirin therapy from 2002 to 2007 (n=11,019). We accounted for appropriate discontinuation because of lack of viral response. RESULTS: Overall, 53% of patients completed at least 38.4 weeks of therapy (80% of the projected 48 weeks), 16.5% discontinued early because of viral nonresponse, and 30.9% discontinued despite viral response or in the absence of virologic data. Cirrhosis, diabetes, pre-treatment substance use disorder, lower baseline concentration of hemoglobin, and lack of hematopoietic growth factor use independently predicted discontinuation within the first 12 weeks (P<.05 for all). Among patients with documented early virologic responses, higher baseline levels of creatinine, depression, and lack of growth factor use predicted discontinuation from 12 to 24 weeks. No factors independently predicted discontinuation from 24 to 48 weeks among patients that responded to treatment at 24 weeks. CONCLUSION: Early discontinuation of antiviral therapy is common. Use of growth factors was the strongest independent predictor of treatment retention before 24 weeks and should be evaluated prospectively. Early interventions are also warranted for other risk factors for early discontinuation, such as pre-existing substance use, depression, comorbid cirrhosis, or diabetes. Copyright © 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

PMID: 20692371 [PubMed - as supplied by publisher]

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