Scott A McDonald1, Hamish A Innes2, Peter C Hayes3, John F Dillon4, Peter R Mills5, David J Goldberg6, Stephen Barclay7, Sam Allen8, Ray Fox5, Andrew Fraser9, Nicholas Kennedy10, Diptendu Bhattacharyya11, Sharon J Hutchinson2. 1. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK; Health Protection Scotland, Meridian Court, Glasgow, Scotland, UK. Electronic address: smcdonald4@nhs.net. 2. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK; Health Protection Scotland, Meridian Court, Glasgow, Scotland, UK. 3. Edinburgh Royal Infirmary, Edinburgh, Scotland, UK. 4. Ninewells Hospital and Medical School, Dundee, Scotland, UK. 5. Gartnavel General Hospital, Glasgow, Scotland, UK. 6. Health Protection Scotland, Meridian Court, Glasgow, Scotland, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK. 7. Glasgow Royal Infirmary, Glasgow, Scotland, UK. 8. Crosshouse Hospital, Kilmarnock, Scotland, UK. 9. Aberdeen Royal Infirmary, Aberdeen, Scotland, UK. 10. Monklands Hospital, Airdrie, Scotland, UK. 11. Kirkcaldy Hospital, Kirkcaldy, UK.
Abstract
BACKGROUND & AIMS: The global burden associated with hepatitis C virus (HCV) infection has prompted a scale-up of antiviral therapy. Hitherto, no data exist on the impact of scaling-up, on the characteristics of treated populations, or on sustained viral response (SVR) rates. We assessed the country-wide scale-up of antiviral therapy in Scotland, a country which nationally monitors uptake of and response to HCV treatment. METHODS: Data for patients, initiated on combined pegylated interferon and ribavirin therapy at 13 specialist HCV clinics in 2001-2010, were extracted from the Scottish HCV Clinical Database (n=3895). Patient characteristics included age, genotype, PWID (people who inject drugs) status, prison referral, and diagnosed cirrhosis. Temporal trends in covariates and adjusted effects on a SVR were examined via mixed-effects regression. RESULTS: The number of patients starting treatment increased from 237 in 2001-2002 to 1560 in 2009-2010, with an increasing trend in SVR from 44% to 57% over this period. For a given clinic, between 2001/2 and 2010 there was a decrease in the odds of those treated being diagnosed with cirrhosis (odds ratio [OR]=0.84 per year), and increasing temporal trends for those treated being PWID (OR=1.08) and prison referrals (OR=1.06). Adjusting for covariates, the proportion of a given clinic's patients achieving SVR was positively associated with the percentage of PWID (OR=1.01 per percent increase; 95% confidence interval [CI]: 1.00-1.02) and genotype 2/3 (OR=1.03; 95% CI: 1.02-1.04). CONCLUSIONS: Despite changes in patient characteristics, a country-wide scale-up of antiviral therapy did not compromise SVR rates. Results are highly relevant to countries planning on scaling-up treatment, given the forthcoming availability of new interferon-free therapies.
BACKGROUND & AIMS: The global burden associated with hepatitis C virus (HCV) infection has prompted a scale-up of antiviral therapy. Hitherto, no data exist on the impact of scaling-up, on the characteristics of treated populations, or on sustained viral response (SVR) rates. We assessed the country-wide scale-up of antiviral therapy in Scotland, a country which nationally monitors uptake of and response to HCV treatment. METHODS: Data for patients, initiated on combined pegylated interferon and ribavirin therapy at 13 specialist HCV clinics in 2001-2010, were extracted from the Scottish HCV Clinical Database (n=3895). Patient characteristics included age, genotype, PWID (people who inject drugs) status, prison referral, and diagnosed cirrhosis. Temporal trends in covariates and adjusted effects on a SVR were examined via mixed-effects regression. RESULTS: The number of patients starting treatment increased from 237 in 2001-2002 to 1560 in 2009-2010, with an increasing trend in SVR from 44% to 57% over this period. For a given clinic, between 2001/2 and 2010 there was a decrease in the odds of those treated being diagnosed with cirrhosis (odds ratio [OR]=0.84 per year), and increasing temporal trends for those treated being PWID (OR=1.08) and prison referrals (OR=1.06). Adjusting for covariates, the proportion of a given clinic's patients achieving SVR was positively associated with the percentage of PWID (OR=1.01 per percent increase; 95% confidence interval [CI]: 1.00-1.02) and genotype 2/3 (OR=1.03; 95% CI: 1.02-1.04). CONCLUSIONS: Despite changes in patient characteristics, a country-wide scale-up of antiviral therapy did not compromise SVR rates. Results are highly relevant to countries planning on scaling-up treatment, given the forthcoming availability of new interferon-free therapies.
Authors: Matthew Hickman; John F Dillon; Lawrie Elliott; Daniela De Angelis; Peter Vickerman; Graham Foster; Peter Donnan; Ann Eriksen; Paul Flowers; David Goldberg; William Hollingworth; Samreen Ijaz; David Liddell; Sema Mandal; Natasha Martin; Lewis J Z Beer; Kate Drysdale; Hannah Fraser; Rachel Glass; Lesley Graham; Rory N Gunson; Emma Hamilton; Helen Harris; Magdalena Harris; Ross Harris; Ellen Heinsbroek; Vivian Hope; Jeremy Horwood; Sarah Karen Inglis; Hamish Innes; Athene Lane; Jade Meadows; Andrew McAuley; Chris Metcalfe; Stephanie Migchelsen; Alex Murray; Gareth Myring; Norah E Palmateer; Anne Presanis; Andrew Radley; Mary Ramsay; Pantelis Samartsidis; Ruth Simmons; Katy Sinka; Gabriele Vojt; Zoe Ward; David Whiteley; Alan Yeung; Sharon J Hutchinson Journal: BMJ Open Date: 2019-09-24 Impact factor: 2.692
Authors: Hamish Innes; Peter Jepsen; Scott McDonald; John Dillon; Victoria Hamill; Alan Yeung; Jennifer Benselin; April Went; Andrew Fraser; Andrew Bathgate; M Azim Ansari; Stephen T Barclay; David Goldberg; Peter C Hayes; Philip Johnson; Eleanor Barnes; William Irving; Sharon Hutchinson; Indra Neil Guha Journal: JHEP Rep Date: 2021-10-07