Wey-Yil Lin1,2,3, Ming-Shyan Lin4, Yi-Hsin Weng2,3,5,6, Tu-Hsueh Yeh7,8, Yu-Sheng Lin4, Po-Yu Fong2,3,5, Yih-Ru Wu2,5, Chin-Song Lu1,2,3,5,6, Rou-Shayn Chen2,3,5, Ying-Zu Huang2,3,5,6,9. 1. Department of Neurology, Landseed International Hospital, Taoyuan, Taiwan. 2. Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. 3. Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. 4. Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan. 5. School of Medicine, Chang Gung University, Taoyuan, Taiwan. 6. Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan. 7. Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan. 8. School of Medicine, Taipei Medical University, Taipei, Taiwan. 9. Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan.
Abstract
IMPORTANCE: Epidemiologic evidence suggests that hepatitis C virus (HCV) could be a risk factor for Parkinson disease (PD), but treatment for HCV infection has never been considered in these studies; hence, the association between antiviral therapy and PD incidence has remained unclear. Understanding this association may help in developing strategies to reduce PD occurrence. OBJECTIVE: To identify the risk of PD development in patients with HCV infection receiving antiviral treatment and in patients not receiving this treatment. DESIGN, SETTING, AND PARTICIPANTS: This cohort study obtained claims data from the Taiwan National Health Insurance Research Database. Adult patients with a new HCV diagnosis with or without hepatitis per International Classification of Diseases, Ninth Revision, Clinical Modification codes and anti-PD medications from January 1, 2003, to December 31, 2013, were selected for inclusion. After excluding participants not eligible for analysis, the remaining patients (n = 188 152) were categorized into treated and untreated groups according to whether they received antiviral therapy. Propensity score matching was performed to balance the covariates across groups for comparison of main outcomes. This study was conducted from July 1, 2017, to December 31, 2017. MAIN OUTCOMES AND MEASURES: Development of PD was the main outcome. A Cox proportional hazards regression model was used to compare the risk of PD, and the hazard ratio (HR) was calculated at 1 year, 3 years, and 5 years after the index date and at the end of the cohort. RESULTS: A total of 188 152 patients were included in the analysis. An equal number (n = 39 936) and comparable characteristics of participants were retained in the treated group (with 17 970 female [45.0%] and a mean [SD] age of 52.8 [11.4] years) and untreated group (with 17 725 female [44.4%] and a mean [SD] age of 52.5 [12.9] years) after matching. The incidence density of PD was 1.00 (95% CI, 0.85-1.15) in the treated group and 1.39 (95% CI, 1.21-1.57) per 1000 person-years in the untreated group. The advantage of antiviral therapy reached statistical significance at the 5-year follow-up (HR, 0.75; 95% CI, 0.59-0.96), and this advantage continued to increase until the end of follow-up (HR, 0.71; 95% CI, 0.58-0.87). CONCLUSIONS AND RELEVANCE: Evidence suggested that the PD incidence was lower in patients with chronic HCV infection who received interferon-based antiviral therapy; this finding may support the hypothesis that HCV could be a risk factor for PD.
IMPORTANCE: Epidemiologic evidence suggests that hepatitis C virus (HCV) could be a risk factor for Parkinson disease (PD), but treatment for HCV infection has never been considered in these studies; hence, the association between antiviral therapy and PD incidence has remained unclear. Understanding this association may help in developing strategies to reduce PD occurrence. OBJECTIVE: To identify the risk of PD development in patients with HCV infection receiving antiviral treatment and in patients not receiving this treatment. DESIGN, SETTING, AND PARTICIPANTS: This cohort study obtained claims data from the Taiwan National Health Insurance Research Database. Adult patients with a new HCV diagnosis with or without hepatitis per International Classification of Diseases, Ninth Revision, Clinical Modification codes and anti-PD medications from January 1, 2003, to December 31, 2013, were selected for inclusion. After excluding participants not eligible for analysis, the remaining patients (n = 188 152) were categorized into treated and untreated groups according to whether they received antiviral therapy. Propensity score matching was performed to balance the covariates across groups for comparison of main outcomes. This study was conducted from July 1, 2017, to December 31, 2017. MAIN OUTCOMES AND MEASURES: Development of PD was the main outcome. A Cox proportional hazards regression model was used to compare the risk of PD, and the hazard ratio (HR) was calculated at 1 year, 3 years, and 5 years after the index date and at the end of the cohort. RESULTS: A total of 188 152 patients were included in the analysis. An equal number (n = 39 936) and comparable characteristics of participants were retained in the treated group (with 17 970 female [45.0%] and a mean [SD] age of 52.8 [11.4] years) and untreated group (with 17 725 female [44.4%] and a mean [SD] age of 52.5 [12.9] years) after matching. The incidence density of PD was 1.00 (95% CI, 0.85-1.15) in the treated group and 1.39 (95% CI, 1.21-1.57) per 1000 person-years in the untreated group. The advantage of antiviral therapy reached statistical significance at the 5-year follow-up (HR, 0.75; 95% CI, 0.59-0.96), and this advantage continued to increase until the end of follow-up (HR, 0.71; 95% CI, 0.58-0.87). CONCLUSIONS AND RELEVANCE: Evidence suggested that the PD incidence was lower in patients with chronic HCV infection who received interferon-based antiviral therapy; this finding may support the hypothesis that HCV could be a risk factor for PD.
Authors: Wenya Yang; Jamie L Hamilton; Catherine Kopil; James C Beck; Caroline M Tanner; Roger L Albin; E Ray Dorsey; Nabila Dahodwala; Inna Cintina; Paul Hogan; Ted Thompson Journal: NPJ Parkinsons Dis Date: 2020-07-09
Authors: Eugenio Mercuri; Francesco Muntoni; Andrés Nascimento Osorio; Már Tulinius; Filippo Buccella; Lauren P Morgenroth; Heather Gordish-Dressman; Joel Jiang; Panayiota Trifillis; Jin Zhu; Allan Kristensen; Claudio L Santos; Erik K Henricson; Craig M McDonald; Isabelle Desguerre Journal: J Comp Eff Res Date: 2020-01-30 Impact factor: 1.744