Alain H Litwin1, Irene J Soloway2, Lauren Cockerham-Colas2, Sheila Reynoso2, Moonseong Heo3, Christopher Tenore4, Robert J Roose5. 1. Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA; Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: alitwin@montefiore.org. 2. Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA. 3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. 4. Albert Einstein College of Medicine, Bronx, NY, USA. 5. Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
Abstract
BACKGROUND: People who inject drugs (PWID) constitute 10 million people globally with hepatitis C virus, including many opioid agonist treatment patients. Little data exist describing clinical outcomes for patients receiving HCV treatment with direct-acting antiviral agents (DAAs) in opioid agonist treatment settings. METHODS: In this retrospective observational study, we describe clinical outcomes for 50 genotype-1 patients receiving HCV treatment with triple therapy: telaprevir (n=42) or boceprevir (n=8) in combination with pegylated interferon and ribavirin on-site in an opioid agonist treatment program. RESULTS: Overall, 70% achieved an end of treatment response (ETR) and 62% achieved a sustained virological response (SVR). These treatment outcomes are nearly equivalent to previously published HCV outcomes shown in registration trials, despite high percentages of recent drug use prior to treatment (52%), ongoing drug use during treatment (45%) and psychiatric comorbidity (86%). Only 12% (n=6) discontinued antiviral treatment early for non-virological reasons. Four patients received a blood transfusion, and one discontinued telaprevir due to severe rash. CONCLUSIONS: These data demonstrate that on-site HCV treatment with direct-acting antiviral agents is effective in opioid agonist treatment patients including patients who are actively using drugs. Future interferon-free regimens will likely be even more effective. Opioid agonist treatment programs represent an opportunity to safely and effectively treat chronic hepatitis C, and PWID should have unrestricted access to DAAs.
BACKGROUND:People who inject drugs (PWID) constitute 10 million people globally with hepatitis C virus, including many opioid agonist treatment patients. Little data exist describing clinical outcomes for patients receiving HCV treatment with direct-acting antiviral agents (DAAs) in opioid agonist treatment settings. METHODS: In this retrospective observational study, we describe clinical outcomes for 50 genotype-1 patients receiving HCV treatment with triple therapy: telaprevir (n=42) or boceprevir (n=8) in combination with pegylated interferon and ribavirin on-site in an opioid agonist treatment program. RESULTS: Overall, 70% achieved an end of treatment response (ETR) and 62% achieved a sustained virological response (SVR). These treatment outcomes are nearly equivalent to previously published HCV outcomes shown in registration trials, despite high percentages of recent drug use prior to treatment (52%), ongoing drug use during treatment (45%) and psychiatric comorbidity (86%). Only 12% (n=6) discontinued antiviral treatment early for non-virological reasons. Four patients received a blood transfusion, and one discontinued telaprevir due to severe rash. CONCLUSIONS: These data demonstrate that on-site HCV treatment with direct-acting antiviral agents is effective in opioid agonist treatment patients including patients who are actively using drugs. Future interferon-free regimens will likely be even more effective. Opioid agonist treatment programs represent an opportunity to safely and effectively treat chronic hepatitis C, and PWID should have unrestricted access to DAAs.
Authors: Paul K Nelson; Bradley M Mathers; Benjamin Cowie; Holly Hagan; Don Des Jarlais; Danielle Horyniak; Louisa Degenhardt Journal: Lancet Date: 2011-07-27 Impact factor: 79.321
Authors: Matthew J Akiyama; Joy I Piotrowski; Marina M Roytman; Siu M A Chan; Leena K Hong; Leslie Huddleston; Ruby Trujillo; Naoky C S Tsai Journal: Hawaii J Med Public Health Date: 2013-09
Authors: Geert Robaeys; Jason Grebely; Stefan Mauss; Philip Bruggmann; Joseph Moussalli; Andrea De Gottardi; Tracy Swan; Amber Arain; Achim Kautz; Heino Stöver; Heiner Wedemeyer; Martin Schaefer; Lynn Taylor; Markus Backmund; Olav Dalgard; Maria Prins; Gregory J Dore Journal: Clin Infect Dis Date: 2013-08 Impact factor: 9.079
Authors: Maria Buti; Kosh Agarwal; Yves Horsmans; William Sievert; Ewa Janczewska; Stefan Zeuzem; Lisa Nyberg; Robert S Brown; Christophe Hézode; Mario Rizzetto; Raymundo Paraná; Sandra De Meyer; Ralph De Masi; Donghan Luo; Kirk Bertelsen; James Witek Journal: Gastroenterology Date: 2013-12-04 Impact factor: 22.682
Authors: Melissa R Stein; Irene J Soloway; Karen S Jefferson; Robert J Roose; Julia H Arnsten; Alain H Litwin Journal: J Subst Abuse Treat Date: 2012-10-02
Authors: Rositsa B Dimova; Marija Zeremski; Ira M Jacobson; Holly Hagan; Don C Des Jarlais; Andrew H Talal Journal: Clin Infect Dis Date: 2012-12-07 Impact factor: 9.079
Authors: Maryam Alavi; Jesse D Raffa; Gregory D Deans; Calvin Lai; Mel Krajden; Gregory J Dore; Mark W Tyndall; Jason Grebely Journal: Liver Int Date: 2013-11-20 Impact factor: 5.828
Authors: Hannah Fraser; Claudia Vellozzi; Thomas J Hoerger; Jennifer L Evans; Alex H Kral; Jennifer Havens; April M Young; Jack Stone; Senad Handanagic; Susan Hariri; Carolina Barbosa; Matthew Hickman; Alyssa Leib; Natasha K Martin; Lina Nerlander; Henry F Raymond; Kimberly Page; Jon Zibbell; John W Ward; Peter Vickerman Journal: Am J Epidemiol Date: 2019-08-01 Impact factor: 4.897
Authors: Judith I Tsui; Claire M Miller; John D Scott; Maria A Corcorran; Julia C Dombrowski; Sara N Glick Journal: Drug Alcohol Depend Date: 2018-12-26 Impact factor: 4.492
Authors: Matthew J Akiyama; Brianna L Norton; Julia H Arnsten; Linda Agyemang; Moonseong Heo; Alain H Litwin Journal: Ann Intern Med Date: 2019-04-09 Impact factor: 25.391
Authors: Kathleen M Ward; Oluwaseun Falade-Nwulia; Juhi Moon; Catherine G Sutcliffe; Sherilyn Brinkley; Taryn Haselhuhn; Stephanie Katz; Kayla Herne; Lilian Arteaga; Shruti H Mehta; Carl Latkin; Robert K Brooner; Mark S Sulkowski Journal: J Infect Dis Date: 2022-03-02 Impact factor: 7.759
Authors: Jason Grebely; Geert Robaeys; Philip Bruggmann; Alessio Aghemo; Markus Backmund; Julie Bruneau; Jude Byrne; Olav Dalgard; Jordan J Feld; Margaret Hellard; Matthew Hickman; Achim Kautz; Alain Litwin; Andrew R Lloyd; Stefan Mauss; Maria Prins; Tracy Swan; Martin Schaefer; Lynn E Taylor; Gregory J Dore Journal: Int J Drug Policy Date: 2015-07-17
Authors: Laura E Starbird; Chakra Budhathoki; Hae-Ra Han; Mark S Sulkowski; Nancy R Reynolds; Jason E Farley Journal: J Viral Hepat Date: 2019-12-09 Impact factor: 3.728
Authors: Benjamin J Eckhardt; Matthew Scherer; Emily Winkelstein; Kristen Marks; Brian R Edlin Journal: Open Forum Infect Dis Date: 2018-03-06 Impact factor: 3.835