Systematic review: patient-reported outcomes in chronic hepatitis C - the impact of liver disease and new treatment regimens

Abstract

Summary Background Treatment for chronic hepatitis C (CH‐C) is rapidly changing and moving away from an interferon and ribavirin‐based therapy to interferon‐free ribavirin‐free all oral regimens. These regimens are simpler and shorter to administer with very high efficacy rates and better side effect profiles. As advances in the treatment of CH‐C occur, it is imperative to capture both clinical outcomes (efficacy and safety) as well as patient‐reported outcomes (PROs). In fact, PROs assesses and quantifies the impact of these regimens on patient experience. PROs assess patients' health‐related quality of life (HRQOL) especially in the realms of fatigue and neuropsychiatric issues such as depression which can affect treatment adherence and work productivity. Aim To review the literature related to PRO's in HCV patients and summarise the impact of CH‐C and its treatment on PROs. Methods Databases Ovid MEDLINE and PubMed were searched from 1990 to October 2014 using a combination of MEsh, thesaurus terms and relevant text words: hepatitis C, CH‐C, treatment, quality of life, health‐related quality of life, fatigue, work productivity, adherence, patient‐reported outcomes, direct acting anti‐viral agents and second generation direct acting anti‐viral agents. Each manuscript was assessed for pertinence to the issue of PROs in CH‐C as well as the quality of study design and publications. Results From the literature, it is evident that CH‐C patients have baseline PRO impairment. Furthermore, treatment with interferon with or without ribavirin and first generation DAAs causes additional PRO burden which can negatively impact treatment adherence and indirectly, treatment efficacy and work productivity. The new treatment regimens with interferon‐ and ribavirin‐free regimens not only have very high efficacy, but also result in the improvement of PRO scores as early as 2 weeks into treatment as well as possibly better adherence to treatment regimens. Conclusions CH‐C and its treatment have been associated with patient‐reported outcome impairment. The new IF‐free and RBV‐free regimens are associated with high efficacy and substantial improvement of patient‐reported outcomes in clinical trial setting. Although very encouraging, more data are needed to assess patient‐reported outcomes, adherence and work productivity of CH‐C patients in the real world setting of clinical practice.

Elimination of hepatitis C virus infection among PWID: The beginning of a new era of interferon-free DAA therapy

“…Mathematical modelling also indicates that DAA treatment of PWID is cost-effective, given the prevention benefit . At an individual level, successful treatment of HCV infection improves health-related quality of life (Younossi & Henry, 2015), reduces the progression of liver disease (Grebely & Dore, 2011) and reduces all-cause mortality in people with advanced liver disease (van der Meer, et al, 2014).…”

The Australasian Hepatology Association consensus guidelines for the provision of adherence support to patients with hepatitis C on direct acting antivirals

“…Obtaining information during treatment on the likelihood of treatment success through viral load testing was identified in one study as an adherence motivator 44. While experience of hepatitis C-related stigma, often related to a history of injecting drug use, was also associated with medication adherence 42,45. Sublette et al42 found that participants reported feeling “unclean” and “embarrassed about divulging their status to doctors and dentists”, but this stigma disappeared once they had been cured of hepatitis C 42.…”

HCV and Work Ability Assessment

“…It is also important to collect patient-reported outcomes, especially ones that capture patients' energy and physical components. Hepatitis C (HCV) infection has a considerable negative impact on patient-reported outcomes (PRO) and patients' WP [2]. Numerous manifestations of HCV lead to an economic burden related to the complications and extrahepatic manifestation, thus decreasing WP [3].…”