Direct acting antiviral treatment of chronic hepatitis C in Denmark

factors associated with and barriers to treatment initiation

Christina Sølund, Sofie Hallager, Martin Schou Pedersen, Ulrik Fahnøe, Anja Ernst, Henrik Bygum Krarup, Birgit Røge, Peer Brehm Christensen, Alex Lund Laursen, Jan Gerstoft, Erika Bélard, Lone Galmstrup Madsen, Kristian Schønning, Anders Gorm Pedersen, Jens Bukh, Nina Weis

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Objectives: We describe factors associated with and barriers to initiation of Direct Acting Antiviral (DAA) treatment in patients with chronic hepatitis C, who fulfill national fibrosis treatment guidelines in Denmark.

Materials and Methods: In this nationwide cohort study, we included patients with chronic hepatitis C from The Danish Database for Hepatitis B and C (DANHEP) who fulfilled fibrosis treatment criteria. Factors associated with treatment initiation and treatment failure were determined by logistic regression analyses. Medical records were reviewed from patients who fulfilled fibrosis treatment criteria, but did not initiate DAA treatment to determine the cause.

Results: In 344 (49%) of 700 patients, who fulfilled treatment criteria, factors associated with DAA treatment initiation were transmission by other routes than injecting drug use odds ratio (OR) 2.13 (CI: 1.38–3.28), previous treatment failure OR 2.58 (CI: 1.84–3.61) and ALT above upper limit of normal OR 1.60 (CI: 1.18–2.17). The most frequent reasons for not starting treatment among 356 (51%) patients were non-adherence to medical appointments (n = 107/30%) and ongoing substance use (n = 61/17%). Treatment failure with viral relapse occurred in 19 (5.5%) patients, who were more likely to have failed previous treatment OR 4.53 (CI: 1.59–12.91).

Conclusions: In this nationwide cohort study, we found non-adherence to medical appointments and active substance use to be major obstacles for DAA treatment initiation. Our findings highlight the need for interventions that can overcome these barriers and increase the number of patients who can initiate and benefit from curative DAA treatment.
OriginalsprogEngelsk
TidsskriftScandinavian Journal of Gastroenterology
Vol/bind53
Udgave nummer7
Sider (fra-til)849-856
ISSN0036-5521
DOI
StatusUdgivet - 2018

Citer dette

Sølund, Christina ; Hallager, Sofie ; Pedersen, Martin Schou ; Fahnøe, Ulrik ; Ernst, Anja ; Krarup, Henrik Bygum ; Røge, Birgit ; Christensen, Peer Brehm ; Laursen, Alex Lund ; Gerstoft, Jan ; Bélard, Erika ; Madsen, Lone Galmstrup ; Schønning, Kristian ; Pedersen, Anders Gorm ; Bukh, Jens ; Weis, Nina. / Direct acting antiviral treatment of chronic hepatitis C in Denmark : factors associated with and barriers to treatment initiation. I: Scandinavian Journal of Gastroenterology. 2018 ; Bind 53, Nr. 7. s. 849-856.
@article{995e262ae6a5467c83194f424581da8d,
title = "Direct acting antiviral treatment of chronic hepatitis C in Denmark: factors associated with and barriers to treatment initiation",
abstract = "Objectives: We describe factors associated with and barriers to initiation of Direct Acting Antiviral (DAA) treatment in patients with chronic hepatitis C, who fulfill national fibrosis treatment guidelines in Denmark.Materials and Methods: In this nationwide cohort study, we included patients with chronic hepatitis C from The Danish Database for Hepatitis B and C (DANHEP) who fulfilled fibrosis treatment criteria. Factors associated with treatment initiation and treatment failure were determined by logistic regression analyses. Medical records were reviewed from patients who fulfilled fibrosis treatment criteria, but did not initiate DAA treatment to determine the cause.Results: In 344 (49{\%}) of 700 patients, who fulfilled treatment criteria, factors associated with DAA treatment initiation were transmission by other routes than injecting drug use odds ratio (OR) 2.13 (CI: 1.38–3.28), previous treatment failure OR 2.58 (CI: 1.84–3.61) and ALT above upper limit of normal OR 1.60 (CI: 1.18–2.17). The most frequent reasons for not starting treatment among 356 (51{\%}) patients were non-adherence to medical appointments (n = 107/30{\%}) and ongoing substance use (n = 61/17{\%}). Treatment failure with viral relapse occurred in 19 (5.5{\%}) patients, who were more likely to have failed previous treatment OR 4.53 (CI: 1.59–12.91).Conclusions: In this nationwide cohort study, we found non-adherence to medical appointments and active substance use to be major obstacles for DAA treatment initiation. Our findings highlight the need for interventions that can overcome these barriers and increase the number of patients who can initiate and benefit from curative DAA treatment.",
author = "Christina S{\o}lund and Sofie Hallager and Pedersen, {Martin Schou} and Ulrik Fahn{\o}e and Anja Ernst and Krarup, {Henrik Bygum} and Birgit R{\o}ge and Christensen, {Peer Brehm} and Laursen, {Alex Lund} and Jan Gerstoft and Erika B{\'e}lard and Madsen, {Lone Galmstrup} and Kristian Sch{\o}nning and Pedersen, {Anders Gorm} and Jens Bukh and Nina Weis",
year = "2018",
doi = "10.1080/00365521.2018.1467963",
language = "English",
volume = "53",
pages = "849--856",
journal = "Scandinavian Journal of Gastroenterology",
issn = "0036-5521",
publisher = "Taylor & Francis",
number = "7",

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Sølund, C, Hallager, S, Pedersen, MS, Fahnøe, U, Ernst, A, Krarup, HB, Røge, B, Christensen, PB, Laursen, AL, Gerstoft, J, Bélard, E, Madsen, LG, Schønning, K, Pedersen, AG, Bukh, J & Weis, N 2018, 'Direct acting antiviral treatment of chronic hepatitis C in Denmark: factors associated with and barriers to treatment initiation', Scandinavian Journal of Gastroenterology, bind 53, nr. 7, s. 849-856. https://doi.org/10.1080/00365521.2018.1467963

Direct acting antiviral treatment of chronic hepatitis C in Denmark : factors associated with and barriers to treatment initiation. / Sølund, Christina; Hallager, Sofie; Pedersen, Martin Schou; Fahnøe, Ulrik; Ernst, Anja; Krarup, Henrik Bygum; Røge, Birgit; Christensen, Peer Brehm; Laursen, Alex Lund; Gerstoft, Jan; Bélard, Erika; Madsen, Lone Galmstrup; Schønning, Kristian; Pedersen, Anders Gorm; Bukh, Jens; Weis, Nina.

I: Scandinavian Journal of Gastroenterology, Bind 53, Nr. 7, 2018, s. 849-856.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Direct acting antiviral treatment of chronic hepatitis C in Denmark

T2 - factors associated with and barriers to treatment initiation

AU - Sølund, Christina

AU - Hallager, Sofie

AU - Pedersen, Martin Schou

AU - Fahnøe, Ulrik

AU - Ernst, Anja

AU - Krarup, Henrik Bygum

AU - Røge, Birgit

AU - Christensen, Peer Brehm

AU - Laursen, Alex Lund

AU - Gerstoft, Jan

AU - Bélard, Erika

AU - Madsen, Lone Galmstrup

AU - Schønning, Kristian

AU - Pedersen, Anders Gorm

AU - Bukh, Jens

AU - Weis, Nina

PY - 2018

Y1 - 2018

N2 - Objectives: We describe factors associated with and barriers to initiation of Direct Acting Antiviral (DAA) treatment in patients with chronic hepatitis C, who fulfill national fibrosis treatment guidelines in Denmark.Materials and Methods: In this nationwide cohort study, we included patients with chronic hepatitis C from The Danish Database for Hepatitis B and C (DANHEP) who fulfilled fibrosis treatment criteria. Factors associated with treatment initiation and treatment failure were determined by logistic regression analyses. Medical records were reviewed from patients who fulfilled fibrosis treatment criteria, but did not initiate DAA treatment to determine the cause.Results: In 344 (49%) of 700 patients, who fulfilled treatment criteria, factors associated with DAA treatment initiation were transmission by other routes than injecting drug use odds ratio (OR) 2.13 (CI: 1.38–3.28), previous treatment failure OR 2.58 (CI: 1.84–3.61) and ALT above upper limit of normal OR 1.60 (CI: 1.18–2.17). The most frequent reasons for not starting treatment among 356 (51%) patients were non-adherence to medical appointments (n = 107/30%) and ongoing substance use (n = 61/17%). Treatment failure with viral relapse occurred in 19 (5.5%) patients, who were more likely to have failed previous treatment OR 4.53 (CI: 1.59–12.91).Conclusions: In this nationwide cohort study, we found non-adherence to medical appointments and active substance use to be major obstacles for DAA treatment initiation. Our findings highlight the need for interventions that can overcome these barriers and increase the number of patients who can initiate and benefit from curative DAA treatment.

AB - Objectives: We describe factors associated with and barriers to initiation of Direct Acting Antiviral (DAA) treatment in patients with chronic hepatitis C, who fulfill national fibrosis treatment guidelines in Denmark.Materials and Methods: In this nationwide cohort study, we included patients with chronic hepatitis C from The Danish Database for Hepatitis B and C (DANHEP) who fulfilled fibrosis treatment criteria. Factors associated with treatment initiation and treatment failure were determined by logistic regression analyses. Medical records were reviewed from patients who fulfilled fibrosis treatment criteria, but did not initiate DAA treatment to determine the cause.Results: In 344 (49%) of 700 patients, who fulfilled treatment criteria, factors associated with DAA treatment initiation were transmission by other routes than injecting drug use odds ratio (OR) 2.13 (CI: 1.38–3.28), previous treatment failure OR 2.58 (CI: 1.84–3.61) and ALT above upper limit of normal OR 1.60 (CI: 1.18–2.17). The most frequent reasons for not starting treatment among 356 (51%) patients were non-adherence to medical appointments (n = 107/30%) and ongoing substance use (n = 61/17%). Treatment failure with viral relapse occurred in 19 (5.5%) patients, who were more likely to have failed previous treatment OR 4.53 (CI: 1.59–12.91).Conclusions: In this nationwide cohort study, we found non-adherence to medical appointments and active substance use to be major obstacles for DAA treatment initiation. Our findings highlight the need for interventions that can overcome these barriers and increase the number of patients who can initiate and benefit from curative DAA treatment.

U2 - 10.1080/00365521.2018.1467963

DO - 10.1080/00365521.2018.1467963

M3 - Journal article

VL - 53

SP - 849

EP - 856

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

SN - 0036-5521

IS - 7

ER -