Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis C
Background. Despite the introduction of direct antiviral agents, pegylated interferon remains the mainstay of treatment for chronic hepatitis C. However, pegylated interferon is associated with a high rate of severe adverse events and decreased quality of life. Specific interventions can improve adh...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2016-07-01
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| Series: | Annals of Hepatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268119311408 |
| _version_ | 1818608152825823232 |
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| author | Marta Gallach Mercedes Vergara Mireia Miquel Meritxell Casas Jordi Sánchez-Delgado Blai Dalmau Montserrat Gil Núria Rudi Isabel Parra Maria López Angelina Dosal Laura Moreno Oliver Valero Xavier Calvet |
| author_facet | Marta Gallach Mercedes Vergara Mireia Miquel Meritxell Casas Jordi Sánchez-Delgado Blai Dalmau Montserrat Gil Núria Rudi Isabel Parra Maria López Angelina Dosal Laura Moreno Oliver Valero Xavier Calvet |
| author_sort | Marta Gallach |
| collection | DOAJ |
| description | Background. Despite the introduction of direct antiviral agents, pegylated interferon remains the mainstay of treatment for chronic hepatitis C. However, pegylated interferon is associated with a high rate of severe adverse events and decreased quality of life. Specific interventions can improve adherence and effectiveness. We aimed to determine whether implementing a multidisciplinary approach improved outcomes in the treatment of chronic hepatitis C.Material and methods. We analyzed consecutive patients treated with pegylated interferon plus ribavirin between August 2001 and December 2011. We compared patients treated before and after the implementation of a multidisciplinary approach in 2007. We compared the baseline demographic and clinical characteristics and laboratory findings between groups, and used bivariate logistic regression models to detect factors involved in attaining a sustained virological response, calculating the odds ratios with their respective 95% confidence intervals. To evaluate the effect of the multidisciplinary team, we fitted a multivariate logistic regression model to compare the sustained virological response after adjusting for unbalanced variables and predictive factors.Results. We included 514 patients [228 (44.4%) in the pre-intervention cohort]. Age, viral genotype, previous treatment, aspartate transaminase, ferritin, and triglyceride were prognostic factors of sustained virological response. After adjusting for prognostic factors, sustained virological response was higher in the multidisciplinary cohort (58 vs. 48%, p = 0.038). Despite higher psychiatric comorbidity and age in the multidisciplinary cohort, we observed a trend toward a lower rate of treatment abandonment in this group (2.2 vs. 4.9%, p = 0.107).Conclusion. Multidisciplinary management of chronic hepatitis C improves outcomes. |
| first_indexed | 2024-12-16T14:38:06Z |
| format | Article |
| id | doaj.art-299c63d1b30e46519f8415bd16435058 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-12-16T14:38:06Z |
| publishDate | 2016-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-299c63d1b30e46519f8415bd164350582022-12-21T22:28:02ZengElsevierAnnals of Hepatology1665-26812016-07-01154524531Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis CMarta Gallach0Mercedes Vergara1Mireia Miquel2Meritxell Casas3Jordi Sánchez-Delgado4Blai Dalmau5Montserrat Gil6Núria Rudi7Isabel Parra8Maria López9Angelina Dosal10Laura Moreno11Oliver Valero12Xavier Calvet13Emergency Department. Universitat Autónoma de Barcelona; Sabadell, Spain; Correspondence and reprint request:Hepatology Unit, Digestive Disease Department. Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain.Hepatology Unit, Digestive Disease Department. Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain.Hospital Pharmacy. Universitat Autónoma de Barcelona; Sabadell, SpainHepatology Unit, Digestive Disease Department. Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain.Hepatology Unit, Digestive Disease Department. Universitat Autónoma de Barcelona; Sabadell, SpainHepatology Unit, Digestive Disease Department. Universitat Autónoma de Barcelona; Sabadell, SpainHospital Pharmacy. Universitat Autónoma de Barcelona; Sabadell, SpainMental Health Department. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.CIBERehd, Instituto Carlos III; Madrid, Spain.; Nursing, Hepatology Day Hospital. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.Nursing, Hepatology Day Hospital. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.Nursing, Hepatology Day Hospital. Hospital de Sabadell, Universitat Autónoma de Barcelona; Sabadell, Spain.Department of Applied Statistics. Universitat Autónoma de Barcelona. Barcelona. Spain.Hepatology Unit, Digestive Disease Department. Universitat Autónoma de Barcelona; Sabadell, Spain; CIBERehd, Instituto Carlos III; Madrid, Spain.Background. Despite the introduction of direct antiviral agents, pegylated interferon remains the mainstay of treatment for chronic hepatitis C. However, pegylated interferon is associated with a high rate of severe adverse events and decreased quality of life. Specific interventions can improve adherence and effectiveness. We aimed to determine whether implementing a multidisciplinary approach improved outcomes in the treatment of chronic hepatitis C.Material and methods. We analyzed consecutive patients treated with pegylated interferon plus ribavirin between August 2001 and December 2011. We compared patients treated before and after the implementation of a multidisciplinary approach in 2007. We compared the baseline demographic and clinical characteristics and laboratory findings between groups, and used bivariate logistic regression models to detect factors involved in attaining a sustained virological response, calculating the odds ratios with their respective 95% confidence intervals. To evaluate the effect of the multidisciplinary team, we fitted a multivariate logistic regression model to compare the sustained virological response after adjusting for unbalanced variables and predictive factors.Results. We included 514 patients [228 (44.4%) in the pre-intervention cohort]. Age, viral genotype, previous treatment, aspartate transaminase, ferritin, and triglyceride were prognostic factors of sustained virological response. After adjusting for prognostic factors, sustained virological response was higher in the multidisciplinary cohort (58 vs. 48%, p = 0.038). Despite higher psychiatric comorbidity and age in the multidisciplinary cohort, we observed a trend toward a lower rate of treatment abandonment in this group (2.2 vs. 4.9%, p = 0.107).Conclusion. Multidisciplinary management of chronic hepatitis C improves outcomes.http://www.sciencedirect.com/science/article/pii/S1665268119311408AdherenceSustained virological responseInterferonRibavirinAdverse events |
| spellingShingle | Marta Gallach Mercedes Vergara Mireia Miquel Meritxell Casas Jordi Sánchez-Delgado Blai Dalmau Montserrat Gil Núria Rudi Isabel Parra Maria López Angelina Dosal Laura Moreno Oliver Valero Xavier Calvet Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis C Annals of Hepatology Adherence Sustained virological response Interferon Ribavirin Adverse events |
| title | Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis C |
| title_full | Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis C |
| title_fullStr | Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis C |
| title_full_unstemmed | Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis C |
| title_short | Effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis C |
| title_sort | effects of a multidisciplinary approach on the effectiveness of antiviral treatment for chronic hepatitis c |
| topic | Adherence Sustained virological response Interferon Ribavirin Adverse events |
| url | http://www.sciencedirect.com/science/article/pii/S1665268119311408 |
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