Australia: Clinical Experience With the Treatment of Hepatitis C Infection in Patients on Opioid Pharmacotherapy
May 20, 2011
The researchers undertook the current project -- a nonrandomized, open-label study -- to evaluate the efficacy, safety, and adherence to hepatitis C virus therapy in patients receiving opioid replacement therapy and attending four tertiary hospital hepatitis clinics in Australia. The participants, 53 individuals with chronic HCV, were treated with pegylated interferon alpha-2a and weight-based ribavirin for 24 weeks (genotype non-1, n=31) or 48 weeks (genotype 1, n=22).
The patients were monitored for virological response, adverse events, and adherence to treatment. Two validated instruments, the Mini International Neuropsychiatric Interview and the Beck Depression Interview, were used before and throughout the study to screen for psychiatric illness.
The group's overall sustained virological response was 57 percent (71 percent for genotype non-1, and 36 percent for genotype 1). The SVR rate was similar for active injectors (63 percent) and noninjectors (53 percent). Patients' psychological profile, as evaluated by the validated instruments, did not change on therapy.
"The pattern and frequency of adverse effects were comparable to nonopioid replacement patients," the authors wrote. According to 80/80/80 criteria -- receiving at least 80 percent of the prescribed interferon, 80 percent of prescribed ribavirin, and remaining in treatment for at least 80 percent of the planned duration -- 85 percent of patients were classified as adherent. Only two individuals who had an end-of-treatment response relapsed, one of whom was not an active injector.
"Patients on opioid replacement therapy, even if they continue to inject actively, can achieve comparable [SVR] rates to other populations with pegylated interferon alpha-2a and ribavirin therapy, suffer no excess rates of adverse effects or psychological complications, and have good adherence to therapy," the researchers concluded.
05.2011; Vol. 106; No. 5: P. 977-984, Joseph John Sasadeusz; Gregory Dore; Ian Kronborg; David Barton; Motoko Yoshihara; Martin Weltman
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