Hepatitis C hospitalizations in Spain and impact of new curative antiviral therapies

Ramos-Rincón, José-Manuel; Pinargote‐Celorio, Héctor; Mendoza, Carmen de; Ramos-Belinchón, Clara; Barreiro, Pablo; Gómez‐Gallego, Félix; Corral, Octavio; Soriano, Vincent

doi:10.1111/jvh.13708

Cited by 10 publications

(5 citation statements)

References 26 publications

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“…It is noteworthy that in-hospital mortality in HBV patients is similar to the death rate in patients admitted with other hepatitis viruses, such as hepatitis C or hepatitis delta. 15,27 It may reflect that once the end-stage liver disease has developed, outcomes in patients with distinct viral hepatitis aetiologies do not differ much.…”

Section: Hepatitis B Hepatitis Deltamentioning

confidence: 99%

Impact of potent nucleos(t)ide therapy on hepatitis B hospitalisations in Spain

Ramos-Rincón

Pinargote‐Celorio

Mendoza

et al. 2022

Aliment Pharmacol Ther

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Summary Background Chronic hepatitis B virus (HBV) infection is a major cause of decompensated cirrhosis and liver cancer worldwide. Newborn HBV vaccination was implemented in Spain two decades ago, and potent oral antivirals entecavir and tenofovir were introduced around 2007. Aim To assess the clinical benefits of these interventions nationwide. Methods Including HBV as a diagnosis, we performed a retrospective study of all hospitalisations in Spain the Spanish National Registry of Hospital Discharges. Information was retrieved from 1997 to 2017. Results From 73,939,642 nationwide hospital admissions during the study period, 129,634 (0.17%) included HBV as diagnosis. Their number doubled from 2007 to 2017 and the median age increased from 44 to 58 years. Most HBV admissions recorded chronic hepatitis B. In‐hospital death occurred in 6.4%. Co‐infection with HIV or hepatitis C virus occurred in 11.9% and 23.3%, respectively. Patients with HIV‐HBV co‐infection had significantly greater mortality than individuals with HBV mono‐infection. The rate of HBV hospitalisations significantly increased over time with a transient drop around 2007, coincident with the arrival of new potent oral antivirals. Although the proportion of HBV hepatic decompensation events has declined, the rate of liver cancer continues to rise. The small subset of patients with hepatitis delta superinfection increasingly and disproportionately accounts for hepatic decompensation events and liver cancer. Conclusion Hospital admissions of individuals with HBV infection are increasing in Spain. While hepatic decompensation events declined following the introduction of potent oral nucleos(t)ide therapy, HBV‐related liver cancer is rising. No benefit of oral antiviral therapies is seen on hepatitis delta.

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Section: Hepatitis B Hepatitis Deltamentioning

confidence: 99%

Impact of potent nucleos(t)ide therapy on hepatitis B hospitalisations in Spain

Ramos-Rincón

Pinargote‐Celorio

Mendoza

et al. 2022

Aliment Pharmacol Ther

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“…The introduction of direct acting antivirals (DAAs) in 2014 lay the foundation for reducing the morbidity and mortality of HCV infections, e.g., by reducing liver decompensation events among hospitalized patients diagnosed with hepatitis C ( 10 ). Several DAA substances have been registered and approved in Germany, and since 2017 single-tablet pan-genotypic combination treatments are available ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Additional challenges in reaching hepatitis C elimination goals in Germany due to the COVID-19 pandemic - descriptive analysis of drug prescription data from January 2018 to June 2021

Meyer

Dudareva

Kollan

et al. 2023

Front. Public Health

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Effectively treating hepatitis C viral (HCV) infections prevents sequelae and onward transmission. In Germany, HCV drug prescriptions have declined since 2015. During the COVID-19 pandemic, lockdowns impacted the access to HCV care services and HCV treatment. We assessed if the COVID-19 pandemic further decreased treatment prescriptions in Germany. We built log-linear models with monthly HCV drug prescription data from pharmacies from January 2018 - February 2020 (pre-pandemic) to calculate expected prescriptions for March 2020-June 2021 and different pandemic phases. We calculated monthly prescription trends per pandemic phase using log-linear models. Further, we scanned all data for breakpoints. We stratified all data by geographic region and clinical settings. The number of DAA prescriptions in 2020 (n = 16,496, −21%) fell below those of 2019 (n = 20,864) and 2018 (n = 24,947), continuing the declining trend from previous years. The drop in prescriptions was stronger from 2019 to 2020 (−21%) than from 2018 to 2020 (−16%). Observed prescriptions met predictions from March 2020 to June 2021, but not during the first COVID-19 wave (March 2020–May 2020). Prescriptions increased during summer 2020 (June 2020-September 2020) and fell below the pre-pandemic numbers during the following pandemic waves (October 2020 – February 2021 and March 2021 – June 2021). Breakpoints during the first wave indicate that prescriptions plummeted overall, in all clinical settings and in four of six geographic regions. Both, outpatient clinics and private practices prescribed overall as predicted. However, outpatient hospital clinics prescribed 17–39% less than predicted during the first pandemic wave. HCV treatment prescriptions declined but stayed within the lower realms of predicted counts. The strongest decline during the first pandemic wave indicates a temporary HCV treatment gap. Later, prescriptions matched predictions despite of pronounced decreases during the second and third waves. In future pandemics, clinics and private practices need to adapt more rapidly to maintain a continuous access to care. In addition, political strategies should focus more on continuously providing essential medical care during periods of restricted access due to infectious disease outbreaks. The observed decrease in HCV treatment may challenge reaching the HCV elimination goals in Germany by 2030.

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“…This reduction was primarily caused by a fall in liver decompensation events. [ 2 ] However, DAA therapy was significantly affected since the onset of COVID‐19, and the pandemic outbreak was associated with a sharp decrease in DAA prescription dispensing, with levels of dispensing remaining below their prepandemic baseline in April 2021. [ 3 ] Doubtless, outcomes of HCV‐related cirrhosis could have been severely affected in the COVID‐19 era.…”

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confidence: 99%

“…I commend the authors for undertaking such a rigorous study and would like to share my suggestions on the potential confounders affecting the outcomes.First, this study's etiologies of liver cirrhosis were not shown in detail. [1] HCV infection is a major cause of liver cirrhosis [2] ; hospital admissions of patients with HCV have significantly declined in Spain since 2015 following a wide prescription of oral direct-acting antivirals (DAAs). This reduction was primarily caused by a fall in liver decompensation events.…”

mentioning

confidence: 99%

“…HCV infection is a major cause of liver cirrhosis2; hospital admissions of patients with HCV have significantly declined in Spain since 2015 following a wide prescription of oral direct‐acting antivirals (DAAs). This reduction was primarily caused by a fall in liver decompensation events 2. However, DAA therapy was significantly affected since the onset of COVID‐19, and the pandemic outbreak was associated with a sharp decrease in DAA prescription dispensing, with levels of dispensing remaining below their prepandemic baseline in April 2021 3.…”

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confidence: 99%

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Letter to the editor: Postvaccination COVID‐19‐related mortality in patients with cirrhosis: Who is the culprit?

Duan

2022

Hepatology

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To the editor, I read with great interest the study by John et al. [1] The authors concluded that though patients with cirrhosis can develop breakthrough COVID-19 after full or partial vaccination, the infections are associated with reduced mortality. I commend the authors for undertaking such a rigorous study and would like to share my suggestions on the potential confounders affecting the outcomes.First, this study's etiologies of liver cirrhosis were not shown in detail. [1] HCV infection is a major cause of liver cirrhosis [2] ; hospital admissions of patients with HCV have significantly declined in Spain since 2015 following a wide prescription of oral direct-acting antivirals (DAAs). This reduction was primarily caused by a fall in liver decompensation events. [2] However, DAA therapy was significantly affected since the onset of COVID-19, and the pandemic outbreak was associated with a sharp decrease in DAA prescription dispensing, with levels of dispensing remaining below their prepandemic baseline in April 2021. [3] Doubtless, outcomes of HCV-related cirrhosis could have been severely affected in the COVID-19 era. I suggest that the etiologies of cirrhosis and DAA therapy for HCV-related cirrhosis should be described and analyzed at baseline.Second, this study's proton pump inhibitor (PPI) exposure was not shown at the baseline. [1] A Veterans Affairs cohort study showed that PPI exposure was associated with an increased risk of infections and decompensation in patients with cirrhosis, which may mediate liver-related mortality. [4] Thus, PPI exposure might be an important potential confounder. PPI use is common in liver cirrhosis, so its effect on liver-related outcomes in this study should be considered.Third, socioeconomic status in this study was unknown. Socioeconomic status was reported to affect COVID-19-related mortality in Santiago, Chile. [5] Furthermore, John et al. [1] mentioned that vaccination distribution varies by region, as seen in their table 1. [1] Thus, socioeconomic status should be considered regarding COVID-19 mortality in this study. AUTHOR CONTRIBUTIONSZhihui Duan: Conceptualization; methodology; formal analysis; writing-original draft; writing-review & editing. CONFLICT OF INTERESTNothing to report.

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Hepatitis C hospitalizations in Spain and impact of new curative antiviral therapies

Cited by 10 publications

References 26 publications

Impact of potent nucleos(t)ide therapy on hepatitis B hospitalisations in Spain

Impact of potent nucleos(t)ide therapy on hepatitis B hospitalisations in Spain

Additional challenges in reaching hepatitis C elimination goals in Germany due to the COVID-19 pandemic - descriptive analysis of drug prescription data from January 2018 to June 2021

Letter to the editor: Postvaccination COVID‐19‐related mortality in patients with cirrhosis: Who is the culprit?

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