Disease Burden, Early Discontinuation, and Healthcare Costs in Hepatitis C Patients with and without Chronic Kidney Disease Treated with Interferon-Free Direct-Acting Antiviral Regimens.
Disease Burden, Early Discontinuation, and Healthcare Costs in Hepatitis C Patients with and without Chronic Kidney Disease Treated with Interferon-Free Direct-Acting Antiviral Regimens.
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DOI：
10.1007/s40261-017-0526-z
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发表时间：
2017-07
影响因子：
3.2
通讯作者：
Schwebke K
中科院分区：
文献类型：
--
作者：
Puenpatom A;Hull M;McPheeters J;Schwebke K
丙型肝炎病毒（HCV）是慢性肾病（CKD）和终末期肾病（ESRD）的危险因素。直接作用抗病毒药物 (DAA) 改善了 CKD 患者的 HCV 管理，但实际临床实践数据有限。本研究调查了在现实环境中接受口服 DAA 的 HCV 患者中 CKD 的患病率。比较患有和不患有 CKD 的患者的合并症、早期停药率和医疗费用。确定了 2013 年 11 月至 2015 年 6 月期间接受口服 DAA 治疗且参加美国健康计划的 HCV 患者。早期停药是根据观察到的治疗持续时间与预期的治疗持续时间进行计算的，而预期的治疗持续时间则基于基因型、初始治疗方案、基线肝硬化和既往治疗。医疗费用是在基线、治疗和治疗后期间计算的。这项研究纳入了 3438 名接受口服 DAA 的患者，其中 6.9% 被诊断为 CKD。与非 CKD 患者相比，CKD 患者多为男性（70.8% vs. 62.9%，p = 0.02）且年龄较大（平均年龄 62.0 vs. 58.8 岁，p < 0.001），并且大多数合并症的患病率较高。在早期停药者中，CKD 患者更有可能出现贫血（19.4% vs. 7.7%，p = 0.028）。很少有 CKD 患者接受 DAA 治疗 HCV 感染。与无 CKD 的患者相比，患有 CKD 的 HCV 患者有明显更多的合并症和更高的基线医疗费用。与非 CKD 患者相比，CKD 患者早期停止 DAA 治疗的可能性相同，但贫血发生率更高。这项研究强调需要更多对肾脏友好的 HCV 疗法。
Hepatitis C virus (HCV) is a risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). Direct-acting antiviral agents (DAAs) have improved HCV management in CKD patients, however real-world clinical practice data are limited. This study examined the prevalence of CKD among HCV patients receiving oral DAAs in a real-world setting. Comorbidities, early discontinuation rates, and healthcare costs were compared between patients with and without CKD. Patients with HCV who were treated with oral DAAs between November 2013 and June 2015, and who were enrolled in a US health plan, were identified. Early discontinuation was calculated based on observed versus expected treatment duration, and expected treatment duration was based on genotype, initial treatment regimen, baseline cirrhosis, and prior treatments. Healthcare costs were calculated during the baseline, treatment, and post-treatment periods. This study included 3438 patients receiving oral DAAs, of whom 6.9% had a CKD diagnosis. CKD patients were more often male (70.8 vs. 62.9%, p = 0.02) and older (mean age 62.0 vs. 58.8 years, p < 0.001) than non-CKD patients, and had a higher prevalence of most comorbidities. Among early discontinuers, CKD patients were more likely to experience anemia (19.4 vs. 7.7%, p = 0.028). Few patients with CKD receive DAA treatment for HCV infections. HCV patients with CKD had significantly more comorbidities and higher baseline healthcare costs than patients without CKD. Compared with non-CKD patients, CKD patients were equally likely to discontinue DAA treatment early but had higher rates of anemia. This study highlights the need for more renal-friendly HCV therapies.