In real-world clinical practice, heterogeneous patient experiences occur during and after direct acting antiviral (DAA) therapy, and symptom improvement is often more pronounced in younger patients, according to a multicenter observational study published in the Journal of Hepatology.1
Patients with hepatitis C virus (HCV) infection often report various symptoms such as neuropsychiatric, somatic, and gastrointestinal symptoms that they attribute to the virus infection.2-4 Studies have demonstrated that health-related quality of life and other patient-reported outcomes improve during DAA therapy,5-7 but a comprehensive analysis of changes in symptoms and functioning during and after DAA therapy for chronic HCV has not been conducted for patients treated in real-world clinical settings. Therefore, researchers in the United States evaluated patient-reported outcomes in a diverse cohort of 1564 patients with HCV treated with commonly-prescribed DAAs (63% were prescribed sofosbuvir/ledipasvir; 21%, sofosbuvir/velpatasvir; 11%, grazoprevir/elbasvir; and 5%, paritaprevir/ombitasvir/ritonavir+dasabuvir).1 Overall, they found that these patients did not experience significant changes in baseline symptoms during treatment. However, they observed a full range of experiences, with some patients experiencing substantial symptom improvement, others experiencing less improvement, and some even experiencing a worsening of symptoms. Of these patients, 1346 were cured of HCV and experienced improvements in fatigue, sleep disturbance, and functional well-being and trends for improvement in pain and depression. However, 64 patients were not cured and experienced minimal improvement.
“This comprehensive assessment of changes in neuropsychiatric, somatic and gastrointestinal symptoms, and functional well-being during and after therapy with all-oral DAA therapies provides new insights relevant to patients, clinicians and other stakeholders,” concluded the authors.1
1. Evon DM, Sarkar S, Amador J, et al. Patient-reported symptoms during and after direct acting antiviral therapies for chronic hepatitis C: The PROP UP Study [published online May 13, 2019]. J Hepatol. doi: 10.1016/j.jhep.2019.04.016.
2. Kleinman L, Mannix S, Yuan Y, Kummer S, L’Italien G, Revicki D. Review of patient-reported outcome measures in chronic hepatitis C. Health Qual Life Outcomes. 2012;10:92.
3. Lang CA, Conrad S, Garrett L, et al. Symptom prevalence and clustering of symptoms in people living with chronic hepatitis C infection. J Pain Symptom Manage. 2006;31:335-344.
4. Ferri C, Ramos-Casals M, Zignego AL, et al. International diagnostic guidelines for patients with HCV-related extrahepatic manifestations. A multidisciplinary expert statement. Autoimmun Rev. 2016;15:1145-1160.
5. Younossi ZM, Stepanova M, Zeuzem S, et al. Patient-reported outcomes assessment in chronic hepatitis C treated with sofosbuvir and ribavirin: The VALENCE study. J Hepatol. 2014;61:228-234.
6. Younossi Z, Henry L. Systematic review: patient-reported outcomes in chronic hepatitis C – the impact of liver disease and new treatment regimens. Aliment Pharmacol Ther. 2015;41:497-520.
7. Younossi ZM, Stepanova M, Feld J, et al. Sofosbuvir/velpatasvir improves patient-reported outcomes in HCV patients: Results from ASTRAL-1 placebo-controlled trial. J Hepatol. 2016;65:33-39.