May 6, 2014

Directly observed therapy for chronic hepatitis C: A randomized clinical trial in the prison setting

Gastroenterol Hepatol. 2014 Apr 28. pii: S0210-5705(14)00081-8. doi: 10.1016/j.gastrohep.2014.03.004. [Epub ahead of print]

Saiz de la Hoya P1, Portilla J2, Marco A3, García-Guerrero J4, Faraco I5, Antón J6, de Juan J7, Pozo E8.


BACKGROUND: The diagnosis and treatment of chronic hepatitis C are major concerns in prisons.

OBJECTIVES: The aim of this randomized clinical trial was to determine the extent to which directly observed therapy (DOT) improved the efficacy of the standard treatment for chronic hepatitis C in the prison setting.

PATIENTS AND METHODS: A randomized clinical trial was carried out to evaluate the efficacy of a DOT compared with a self-administered therapy in prison inmates who underwent standard treatment for chronic hepatitis C (based on pegylated interferon alpha-2a and ribavirin).

RESULTS: A total of 252 inmates were randomized, of which 244 were analyzed: 109 in the DOT group and 135 in the non-DOT group. The mean age was 35.88 years (SD 6.54), 94.3% were men, 72.1% reported intravenous drug use, 21.3% were HIV co-infected, and 55.3% had genotype 1 or 4. The patients received the study treatment for a median time of 33.9 weeks in the overall sample. Sustained virological response was achieved in 60.6% (95% CI, 51.17-69.22) of the DOT group and in 65.9% (95% CI, 57.59-73.38) of the standard therapy group (risk ratio=0.92; 95% CI, 0.76-1.12). The mean proportion of patients continuing the treatment was 83% (SD=31). Adverse events were reported in 93.4% of the patients, and serious adverse events were reported in 8.2%, with no significant differences between groups.

CONCLUSIONS: Sustained virological response was remarkably high, although there were no differences between groups, probably due to high treatment adherence.

Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

KEYWORDS: Chronic hepatitis C, Directly observed therapy, HCC, HCV, Hepatitis C crónica, Interferón pegilado, Pegylated interferon, Ribavirin, Ribavirina, Tratamiento directamente observado

PMID: 24786935 [PubMed - as supplied by publisher]


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