High Effectiveness of Broad Access Direct‐Acting Antiviral Therapy for Hepatitis C in an Australian Real‐World Cohort: The REACH‐C Study

Yee, Jasmine; Carson, Joanne; Hajarizadeh, Behzad; Hanson, Joshua; O’Beirne, James; Iser, David; Read, Phillip; Balcomb, Anne; Doyle, Joseph; Davies, Jane; Martinello, Marianne; Marks, Philiipa; Dore, Gregory J.; Matthews, Gail

doi:10.1002/hep4.1826

Cited by 15 publications

(22 citation statements)

References 36 publications

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“…In this study, antiviral treatment was just as effective for First Nations Peoples with HCV as for non-Indigenous Australians with these real-world Australian data consistent with clinical trials and other treatment settings [14][15][16]. In 2017, HCV notification rate in the First Nations Peoples in 5 Australian jurisdictions was 4.4 times higher than that of non-Indigenous Australians (168.1 per 100 000 vs. 38.4 per 100,000, respectively), and they had lower lifetime (37% vs. 47%) uptake of treatment [17].…”

Section: Discussionsupporting

confidence: 76%

“…In a recent Australian HCV study (REACH-C) [16], younger age was independently associated with LTFU in a cohort of Australians treated with DAA (adj-OR = 0.97, 95% CI 0.97-0.98, p < 0.01). Other predictors of LTFU were IDU and initiation of treatment after 2016, while HIV coinfection and previous interferon-based HCV treatment were associated with decrease in LTFU.…”

Section: Discussionmentioning

confidence: 96%

“…Logistic MVA assessed factors associated with LTFU among First Nations Peoples. The final logistic multivariable model was determined based on the results of the bi-variable analysis but also taking into account our understanding of the relationships and dependencies among variables, their clinical relevance, our previous analysis of this cohort [6], and informed by a previous study on LTFU in HCV care population [16]. The final model included age, FIB-4 score, number of comorbidities assessed by the RxRisk, Year of HCV treatment initiation, and type of service.…”

Section: Discussionmentioning

confidence: 99%

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Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up

et al. 2022

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Background First Nations Peoples of Australia are disproportionally affected by hepatitis C (HCV) infection. Through a prospective study we evaluated the outcome of direct-acting antiviral (DAA) therapy among First Nations Peoples with HCV infection. Methods Adults who initiated DAA therapy at one of 26 hospitals across Australia, 2016–2019 were included in the study. Clinical data were obtained from medical records and the Pharmaceutical and Medicare Benefits Schemes. Outcomes included sustained virologic response (SVR) and loss to follow-up (LTFU). A multivariable analysis assessed factors associated with LTFU. Results Compared to non-Indigenous Australians (n = 3206), First Nations Peoples (n = 89) were younger (p < 0.001), morel likely to reside in most disadvantaged (p = 0.002) and in regional/remote areas (p < 0.001), and had similar liver disease severity. Medicines for mental health conditions were most commonly dispensed among First Nations Peoples (55.2% vs. 42.8%; p = 0.022). Of 2910 patients with follow-up data, both groups had high SVR rates (95.3% of First Nations Peoples vs. 93.2% of non-Indigenous patients; p = 0.51) and ‘good’ adherence (90.0% vs. 86.9%, respectively; p = 0.43). However, 28.1% of First Nations Peoples were LTFU vs. 11.2% of non-Indigenous patients (p < 0.001). Among First Nations Peoples, younger age (adj-OR = 0.93, 95% CI 0.87–0.99) and treatment initiation in 2018–2019 vs. 2016 (adj-OR = 5.14, 95% CI 1.23–21.36) predicted LTFU, while higher fibrosis score was associated with better engagement in HCV care (adj-OR = 0.71, 95% CI 0.50–0.99). Conclusions Our data showed that First Nations Peoples have an equivalent HCV cure rate, but higher rates of LTFU. Better strategies to increase engagement of First Nations Peoples with HCV care are needed.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up

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“…The increasing trend in treatment discontinuation observed in this study corresponds with the expansion of treatment through diverse models of care and increasing treatment uptake among people who inject drugs. 6 , 12 Between 2015 and 2021, the proportion of people who inject drugs attending needle and syringe programs reporting ever receiving HCV treatment increased from 11% to 62%. 12 By 2021, 1 in 5 people aged under 35 (19%), an age group with higher rates of injecting drug use risk behaviors, 13 discontinued treatment for HCV.…”

Section: Discussionmentioning

confidence: 99%

“… 4 In Australia, treatment patterns have changed over time, with older individuals with advanced liver disease initially prioritized, and subsequently broadening to younger populations, including people who inject drugs. 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

Increasing national trend of direct-acting antiviral discontinuation among people treated for HCV 2016–2021

Carson

Barbieri

Matthews

et al. 2023

Hepatology Communications

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Background: Direct-acting antiviral (DAA) treatment discontinuation may negatively impact HCV elimination efforts. In Australia, DAA therapy is pharmacy dispensed, generally in 4-week amounts, with the approved duration (8–24 wk) and volume dispensed reported in pharmaceutical administrative data. This analysis assessed national HCV treatment discontinuation. Methods: Individuals commencing DAAs between 2016 and 2021 were assessed for treatment discontinuation. Individuals with a single dispensation of their entire treatment course were excluded. Treatment discontinuation was defined as ≥4 weeks of approved treatment duration not dispensed. Factors associated with treatment discontinuation were assessed using Cox regression. Factors associated with retreatment following treatment discontinuation were assessed using logistic regression. Results: Of 95,275 individuals who were treated, 88,986 were included in the analysis of whom 7532 (9%) discontinued treatment. Treatment discontinuation increased from 6% in the first half of 2016 to 15% in 2021. Longer treatment durations (vs. 8 wk) were associated with increased discontinuation risk (12 wk: adjusted HR = 3.23; 95% CI: 2.90, 3.59; p < 0.001, 16–24 wk: adjusted HR = 6.29; 95% CI: 5.55, 7.14; p < 0.001). Of individuals discontinuing treatment, 24% were retreated. Early discontinuation (4 wk treatment dispensed) increased the likelihood of retreatment (adjusted OR = 3.91; 95% CI: 3.44, 4.44; p < 0.001). Those with early discontinuation of glecaprevir/pibrentasvir 8 weeks (vs. sofosbuvir/velpatasvir 12 wk) had a lower likelihood of retreatment (adjusted OR = 0.62; 95% CI: 0.49, 0.79; p < 0.001). Initial treatment discontinuation was associated with an increased risk of retreatment discontinuation (adjusted HR = 4.41; 3.85, 5.05; p < 0.001). Conclusions: DAA treatment discontinuation increased over time corresponding to increasing treatment uptake through primary care among people who inject drugs. The use of simplified, short-duration therapies may reduce treatment discontinuation. Access to adherence support and retreatment will be essential for HCV elimination.

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Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort

et al. 2022

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Background and Aims In 2016, direct-acting antiviral (DAA) treatment for hepatitis C (HCV) became available through Australia’s universal health care system, with the aim of HCV elimination. We report real-world effectiveness of DAA HCV treatment in Australia from a clinically well-informed cohort, enriched for cirrhosis and prior HCV treatment. Methods 3413 patients were recruited from 26 hospital liver clinics across Australia from February 2016 to June 2020. Clinical history and sustained viral response (SVR) were obtained from medical records and data linkage to the Australian Pharmaceutical Benefits Scheme. Factors associated with SVR were assessed by multivariable logistic regression (MVR). Results At recruitment, 32.2% had cirrhosis (72.9% Child Pugh class B/C), and 19.9% were treatment experienced. Of the 2,939 with data, 93.3% confirmed SVR. 137 patients received second-line therapy. Patients with cirrhosis had lower SVR rate (88.4 vs. 95.8%; p < 0.001). On MVR, failure to achieve SVR was associated with Genotype 3 (adj-OR = 0.42, 95%CI 0.29–0.61), male gender (adj-OR = 0.49, 95%CI 0.31–0.77), fair/poor adherence (adj-OR = 0.52, 95%CI 0.28–0.94), cirrhosis (adj-OR = 0.57, 95%CI 0.36–0.88), FIB-4 > 3.25 (adj-OR = 0.52, 95%CI 0.33–0.83) and MELD score ≥ 20 (adj-OR = 0.25, 95%CI 0.08–0.80). Consistent results were seen in cirrhotic sub-analysis. Conclusions Excellent SVR rates were achieved with DAAs in this real-world cohort of patients with chronic HCV infection. More advanced liver disease and clinician impression of poor adherence were associated with HCV treatment failure. Supports to improve liver fibrosis assessment skills for non-specialist DAA prescribers in the community and to optimize patient adherence are likely to enable more effective pursuit of HCV elimination in Australia. Supplementary Information The online version contains supplementary material available at 10.1007/s10620-022-07483-y.

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High Effectiveness of Broad Access Direct‐Acting Antiviral Therapy for Hepatitis C in an Australian Real‐World Cohort: The REACH‐C Study

Cited by 15 publications

References 36 publications

Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up

Hepatitis C treatment outcomes for Australian First Nations Peoples: equivalent SVR rate but higher rates of loss to follow-up

Increasing national trend of direct-acting antiviral discontinuation among people treated for HCV 2016–2021

Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort

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