Impact of pegylated interferon and ribavirin on morbidity and mortality in patients with chronic hepatitis C and normal aminotransferases in France.

Details

Serval ID
serval:BIB_B70F9FA38A7D
Type
Article: article from journal or magazin.
Collection
Publications
Title
Impact of pegylated interferon and ribavirin on morbidity and mortality in patients with chronic hepatitis C and normal aminotransferases in France.
Journal
Hepatology
Author(s)
Deuffic-Burban S., Babany G., Lonjon-Domanec I., Deltenre P., Canva-Delcambre V., Dharancy S., Louvet A., Roudot-Thoraval F., Mathurin P.
ISSN
1527-3350 (Electronic)
ISSN-L
0270-9139
Publication state
Published
Issued date
2009
Volume
50
Number
5
Pages
1351-1359
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Abstract
Clinicians continue to raise questions concerning the necessity of treating chronic hepatitis C virus (HCV)-infected patients with normal alanine aminotransferase (N-ALT), in light of their slower progression to cirrhosis than patients with elevated alanine aminotraferase (E-ALT). This study was undertaken to predict the impact of pegylated interferon (IFN) and ribavirin on HCV-related morbidity and mortality in patients with N-ALT. A previous Markov model was adapted to separately simulate patients with N-ALT (30%) and those with E-ALT (70%). The model estimates fibrosis progression rates according to age, sex, and whether ALT levels are normal or elevated, assuming that patients with E-ALT have a 2.6 times higher progression than those with N-ALT. It takes into account improvement in HCV screening and treatment and competitive mortality. We assumed that N-ALT patients were treated 80% less frequently between 2002 and 2004 and 70% less frequently from 2005 on, as obtained in real life from three multicentric cohorts (Hepatys, Adequation, Persee). Antiviral treatment of HCV-infected populations might reduce 2008-2025 HCV-related morbidity and mortality by 34,200 cases of cirrhosis (36%, 33,000-35,000), 22,400 complications (28%, 21,000-23,000) and 17,500 deaths (25%, 17,000-18,000), including 3000 cases of cirrhosis (22%, 2000-5000), 1200 complications (15%, 1000-1700), and 1000 deaths (14%, 900-1300) in the N-ALT population, despite a probability of receiving treatment that is three to five times less in this population. If N-ALT patients are treated at the same proportions as those with E-ALT, morbidity and mortality could be further reduced by 1400 cases of cirrhosis (13%, 1200-2200), 600 complications (9%, 600-1000), and 500 deaths (9%, 500-800).
CONCLUSION: Treatment of N-ALT patients would decrease HCV morbidity and mortality. These patients should be considered candidates for treatment just as others are.
Keywords
Adolescent, Adult, Aged, Alanine Transaminase/blood, Antiviral Agents/therapeutic use, Child, Child, Preschool, Disease Progression, Drug Therapy, Combination, Female, France, Hepatitis C, Chronic/blood, Hepatitis C, Chronic/drug therapy, Humans, Infant, Infant, Newborn, Interferon-alpha/therapeutic use, Male, Middle Aged, Patient Selection, Polyethylene Glycols/therapeutic use, Recombinant Proteins, Retrospective Studies, Ribavirin/therapeutic use, Sensitivity and Specificity, Young Adult
Pubmed
Web of science
Open Access
Yes
Create date
06/12/2013 10:13
Last modification date
20/08/2019 15:25
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