A multi-disciplinary approach to treating hepatitis C with interferon and ribavirin in alcohol-dependent patients with ongoing abuse

CHU de Rennes, Unité d'Addictologie, F-35033 Rennes, France.
Journal of Hepatology (Impact Factor: 11.34). 07/2011; 56(2):334-40. DOI: 10.1016/j.jhep.2011.05.021
Source: PubMed


Guidelines recommend 6 months of alcohol abstinence before treating hepatitis C (HCV). Abstinence is difficult for alcohol-dependent patients to achieve. This study evaluated HCV treatment in alcoholic patients with ongoing consumption or less than 6 months of abstinence.
A multidisciplinary management model was built by a liver unit and two centers involved in the care of addict patients. Patients were included in a prospective observational study of treatment with pegylated interferon and ribavirin if they presented alcohol dependence with ongoing intoxication or abstinence of less than 6 months. Pre-therapeutic evaluation and follow-up were multidisciplinary, and addiction care was personalized to patient condition and willingness. Alcohol abstinence or reduction was encouraged but not mandatory. The primary end point was sustained virological response (SVR). Results were compared to a control group of patients matched for genotype, viral load, fibrosis stage, sex, and age.
A total of 73 patients treated between 2002 and 2008 were included in the study. Intent to treat analysis showed an SVR in 48% (35/73) of patients versus 49% (36/73) of controls. Low viral load and length of abstinence during treatment were independently associated with SVR. During treatment, 20 (27%) patients were abstinent, 23 (32%) had controlled consumption, and 24 (33%) had excessive consumption. At the end of the follow-up, 22 (30%) patients were durably abstinent.
A multidisciplinary approach allowed HCV treatment in alcohol-dependent patients with a satisfactory SVR rate and positive effects on addiction behavior.

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    • "However, substance abuse and psychiatric comorbidities are common in patients with CHC [4] [5], and adverse effects by PegIFN very frequently occur, leading to lower SVR rates [6]. Recent studies have shown a significant increase of adherence and effectiveness with the implementation of some specific interventions [7] [8]. However, the impact of a multidisciplinary support program (MSP) designed Journal of Hepatology 2013 vol. "
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    ABSTRACT: Adherence to antiviral treatment is important to achieve sustained virological response (SVR) in chronic hepatitis C (CHC). We evaluated the efficiency of a multidisciplinary support programme (MSP), based on published HIV treatment experience, to increase patient adherence and the efficacy of pegylated interferon alfa-2a and ribavirin in CHC. 447 patients receiving antiviral treatment were distributed into 3 groups: control group (2003-2004, n= 147), MSP group (2005-2006, n=131), and MSP-validation group (2007-2009, n=169). The MSP group included two hepatologists, two nurses, one pharmacist, one psychologist, one administrative assistant and one psychiatrist. Cost-effectiveness analysis was performed using a Markov model. Adherence and SVR rates were higher in the MSP (94.6% and 77.1%) and MSP-validation (91.7% and 74.6%) groups compared to controls (78.9% and 61.9%)(p<0.05 in all cases). SVR was higher in genotypes 1 or 4 followed by the MSP group vs. controls (67.7% vs. 48.9%, p=0.02) compared with genotypes 2 or 3 (87.7% vs. 81.4%, p=ns). The MSP was the main predictive factor of SVR in patients with genotype 1. The rate of adherence in patients with psychiatric disorders was higher in the MSP groups (n=95, 90.5%) compared to controls (n=28, 75.7%)(p= 0.02). The cost per patient was € 13,319 in the MSP group and € 16,184 in the control group. The MSP group achieved more quality-adjusted life years (QALYs) (16.317 QALYs) than controls (15.814 QALYs) and was dominant in all genotypes. MSP improves patient compliance and increases the efficiency of antiviral treatment in CHC, being cost-effective.
    Journal of Hepatology 06/2013; 59(5). DOI:10.1016/j.jhep.2013.06.019 · 11.34 Impact Factor
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    • "There was, however, a trend toward a better outcome in patients who remained abstinent throughout treatment. In the same line of evidence, Le Lan et al. have reported a significantly higher rate of SVR in former heavy drinkers who remained abstinent throughout antiviral therapy compared with patients with ongoing alcohol consumption (Le Lan et al., 2012). It is noteworthy that most heavy drinkers at the beginning of the study had reduced their consumption before initiation of therapy or during treatment. "
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    ABSTRACT: AimOptimal management of hepatitis C virus (HCV) infection is controversial in heavy drinkers. We compared the management of HCV infection of heavy drinkers with that of patients without a history of alcohol abuse.Methods In a retrospective case-control study, 69 HCV-infected heavy drinkers [daily alcohol consumption at referral above 60 g/day, hereafter 'alcohol group'] were compared with matched HCV-infected patients with low alcohol consumption (<40 g/day, 'control group').ResultsPatients of the 'alcohol group' were younger (42 vs. 45 years, P = 0.05), more often male (69.6 vs. 56.5%, P = 0.11) and had been infected by intravenous drug use (85.5 vs. 45.0%, P < 0.0001). The percentage of patients with a recommendation for treatment according to the French 2002 consensus (bridging fibrosis or genotype 2 or 3) was 52 of 69 (75.4%) in both groups, while the proportion of patients treated was higher in the control group (71.0 vs. 44.9%, P = 0.002). In the 'alcohol group', patients had better access to treatment if they were employed or consumed 170 g/day or less at first referral. Sustained virological response (SVR) was obtained in 10 of 31 patients (32.3%) of the 'alcohol group' vs. 8 of 31 patients (25.8%) of the control group matched for genotype and type of treatment (P = 0.58).Conclusion Heavy drinkers are less often considered for antiviral therapy compared with patients without a history of alcohol abuse. However, once treatment is actually initiated, SVR rates are comparable with those achieved in non-drinkers despite the continuation of alcohol consumption during therapy in some patients.
    Alcohol and Alcoholism 03/2013; 48(3). DOI:10.1093/alcalc/agt020 · 2.89 Impact Factor
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    Journal of Hepatology 03/2012; 57(1):167-85. DOI:10.1016/j.jhep.2012.02.010 · 11.34 Impact Factor
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