Priya Simoes1, Adel Asaad1, Jean Abed1, Ellen S Engelson2, Donald P Kotler3. 1. Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York. 2. Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York. 3. Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, St. Luke's and Roosevelt Hospitals, New York, New York. Electronic address: dkotler@chpnet.org.
Abstract
INTRODUCTION: Hepatitis C virus (HCV) is the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation in the United States. Response to treatment has improved with the addition of direct acting protease inhibitors. However, there are limited real-world data on the role of gender in achieving a sustained virologic response (SVR). METHODS: We conducted a cross-sectional study in 70 patients treated for HCV, genotype 1 infection with pegylated alpha interferon, ribavirin, and either telaprevir or boceprevir at our inner-city liver clinic. RESULTS: The SVR was significantly lower in women than in men (24% vs. 59%; p < .01). Statistical significance persisted after adjusting for age, race, genotype, prior treatment status, duration of therapy, and stage of fibrosis. The adjusted odds ratio for achieving SVR was significantly lower in women than in men (odds ratio [OR], 0.13; 95% CI, 0.03-0.58; p = .01). Relapse after completing treatment was more likely to occur in women (p = .02). Thirty-four patients (48%) did not complete therapy. Discontinuation because of loss to follow-up was more likely in women, whereas discontinuation owing to therapy limiting adverse drug events were more common in men. Discontinuation rates owing to failure of therapy were similar in men and women. CONCLUSIONS: There was a significant difference in SVR between men and women. Both biological and nonbiological factors, the latter including access to care, adherence to therapy, and attitudes of and toward health care providers all could play a role in contributing to the observed disparity between sexes in treatment response.
INTRODUCTION:Hepatitis C virus (HCV) is the leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation in the United States. Response to treatment has improved with the addition of direct acting protease inhibitors. However, there are limited real-world data on the role of gender in achieving a sustained virologic response (SVR). METHODS: We conducted a cross-sectional study in 70 patients treated for HCV, genotype 1 infection with pegylated alpha interferon, ribavirin, and either telaprevir or boceprevir at our inner-city liver clinic. RESULTS: The SVR was significantly lower in women than in men (24% vs. 59%; p < .01). Statistical significance persisted after adjusting for age, race, genotype, prior treatment status, duration of therapy, and stage of fibrosis. The adjusted odds ratio for achieving SVR was significantly lower in women than in men (odds ratio [OR], 0.13; 95% CI, 0.03-0.58; p = .01). Relapse after completing treatment was more likely to occur in women (p = .02). Thirty-four patients (48%) did not complete therapy. Discontinuation because of loss to follow-up was more likely in women, whereas discontinuation owing to therapy limiting adverse drug events were more common in men. Discontinuation rates owing to failure of therapy were similar in men and women. CONCLUSIONS: There was a significant difference in SVR between men and women. Both biological and nonbiological factors, the latter including access to care, adherence to therapy, and attitudes of and toward health care providers all could play a role in contributing to the observed disparity between sexes in treatment response.
Authors: Lisa R Metsch; Daniel J Feaster; Lauren K Gooden; Carmen Masson; David C Perlman; Mamta K Jain; Tim Matheson; C Mindy Nelson; Petra Jacobs; Susan Tross; Louise Haynes; Gregory M Lucas; Jonathan A Colasanti; Allan Rodriguez; Mari-Lynn Drainoni; Georgina Osorio; Ank E Nijhawan; Jeffrey M Jacobson; Meg Sullivan; David Metzger; Pamela Vergara-Rodriguez; Ronald Lubelchek; Rui Duan; Jacob N Batycki; Abigail G Matthews; Felipe Munoz; Eve Jelstrom; Raul Mandler; Carlos Del Rio Journal: Open Forum Infect Dis Date: 2021-06-27 Impact factor: 4.423