Comparative Effectiveness of Direct-Acting Antivirals for Posttraumatic Stress Disorder in Veterans Affairs Patients With Hepatitis C Virus Infection.
Comparative Effectiveness of Direct-Acting Antivirals for Posttraumatic Stress Disorder in Veterans Affairs Patients With Hepatitis C Virus Infection.
复制标题
直接作用抗病毒药物治疗丙型肝炎病毒感染退伍军人事务部患者创伤后应激障碍的比较疗效。
DOI：
10.1093/aje/kwac104
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发表时间：
2022
影响因子：
5
通讯作者：
Gradus,JaimieL
中科院分区：
文献类型：
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作者：
Shiner,Brian;Huybrechts,Krista;Gui,Jiang;Rozema,Luke;Forehand,Jenna;Watts,BradleyV;Jiang,Tammy;Hoyt,JessicaE;Esteves,Jack;Schnurr,PaulaP;Ray,Kristen;Gradus,JaimieL
我们最近进行的一项探索性研究表明，在1999年10月1日至2019年9月30日期间接受治疗的美国退伍军人事务部(VA)全国队列患者中，几种直接作用抗病毒药物(DAA)也与改善创伤后应激障碍(PTSD)有关，DAA是治疗丙型肝炎病毒(HCV)感染的高效药物。将相同的队列限制在PTSD和丙型肝炎患者中，我们使用倾向记分权重法比较了个体DAA与PTSD症状改善的相关性。在用创伤后应激障碍检查表(PCL)确定有可用的基线和终点创伤后应激障碍症状数据的患者后，我们比较了DAA治疗8-12周期间的变化。与PCL测量结合使用最多的DAA是格列帕韦/匹布列韦(GLE/PIB；n=54)、索那布韦/维帕他韦(SOF/VEL；n=54)和利地帕韦/索布沙韦(LDV/SOF；n=145)。GLE/PIB组优于LDV/SOF组，PCL评分平均改善7.3分(95%可信区间：1.1，13.6)。GLE/PIB组与SOF/VEL组(3.0，95%CI：−6.3，12.2)和SOF/VEL组(4.4，95%CI：−2.4，11.2)的PCL改善程度差异较小。虽然几乎所有患者(92.5%)都治愈了丙型肝炎病毒(92.5%)，但接受GLE/PIB治疗的PTSD结果优于接受LDV/SOF治疗的患者，这表明GLE/PIB作为一种潜在的PTSD治疗方法可能值得进一步研究。
We recently conducted an exploratory study that indicated that several direct-acting antivirals (DAAs), highly effective medications for hepatitis C virus (HCV) infection, were also associated with improvement in posttraumatic stress disorder (PTSD) among a national cohort of US Department of Veterans Affairs (VA) patients treated between October 1, 1999, and September 30, 2019. Limiting the same cohort to patients with PTSD and HCV, we compared the associations of individual DAAs with PTSD symptom improvement using propensity score weighting. After identifying patients who had available baseline and endpoint PTSD symptom data as measured with the PTSD Checklist (PCL), we compared changes over the 8–12 weeks of DAA treatment. The DAAs most prescribed in conjunction with PCL measurement were glecaprevir/pibrentasvir (GLE/PIB;n= 54), sofosbuvir/velpatasvir (SOF/VEL;n= 54), and ledipasvir/sofosbuvir (LDV/SOF;n= 145). GLE/PIB was superior to LDV/SOF, with a mean difference in improvement of 7.3 points on the PCL (95% confidence interval (CI): 1.1, 13.6). The mean differences in improvement on the PCL were smaller between GLE/PIB and SOF/VEL (3.0, 95% CI: −6.3, 12.2) and between SOF/VEL and LDV/SOF (4.4, 95% CI: −2.4, 11.2). While almost all patients were cured of HCV (92.5%) regardless of the agent received, PTSD outcomes were superior for those receiving GLE/PIB compared with those receiving LDV/SOF, indicating that GLE/PIB may merit further investigation as a potential PTSD treatment.