Poster Session 1: Practice Issues; Signal Transduction and Nuclear Receptorsстатья из журнала
Аннотация: Background: The advent of directly acting anti-virals (DAA) has led to simplified HCV regimens with increased efficacy rates and better tolerability.The high adherence seen in clinical trials may not translate to real life populations.Optimal adherence is critical to protect patients from treatment failure and resistance.Aim: To identify potential factors which may contribute to sub-optimal adherence in a population with decompensated cirrhosis.Methods: HCV patients eligible for access to a 12 week treatment regimen under a UK NHSE mandated access scheme were consented to complete a baseline questionnaire capturing data on sociodemographics, clinical status and perceptions of illness.Adherence assessments at treatment weeks 4, 8 and 12 with pill counts and a Morisky Medication Adherence Scale were undertaken.Suboptimal adherence (SA) was defined as any report or pill count which indicated a delayed (>2hrs) or missed dose of anti-viral.Descriptive statistic and multivariate regression methods were utilised for analysis.Results: 80% (n=47) of the cohort had reached SVR 12 and are included in the adherence analysis.85%received sofosbuvir/ledipasvir and 15% sofosbuvir with daclatasvir.All patients received ribavirin and had been attending specialist hepatology services for >12 months.43%(n=20) of patients demonstrated SA during their treatment.Multivariate analysis demonstrated that any non-attendance during treatment and a 'limited support network' predicted higher rates of SA (p<0.05).In the SA group, 80% were taking >3 medications (vs 74% in adherent group).The average MELD score was 15 in the SA group (vs 13 in adherent group).80% of SA was associated with symptoms secondary to disease stage not reflected by the MELD.SA secondary to side effects of therapy was not identified.85% of the SA group achieved SVR12.Failure to achieve SVR was seen in those with SA adherence at all assessment points (weeks 4, 8 and 12).Conclusions: Our initial results demonstrate that despite an intensive adherence focused multi-disciplinary approach, SA occurs in decompensated HCV cirrhotic patients.Acceptable SVR rates were achieved in this population.Further research is warranted to develop strategies which maximise adherence in all HCV populations.
Год издания: 2015
Авторы: Aisling Considine, Suman Verma, Kath Oakes, Kate Childs, Sarah Knighton, Andrew Ayers, Abid Suddle, Kosh Agarwal, Colina Yim, Cheryl Dale, Geri Hirsch, Jo‐Ann Ford, Caro- Lyn Klassen, Carolyn Klassen, Heather Johnson, Emily M. Graham, Michael A. Dunn, Kapil Chopra, Anna Moles, Jacqueline Butterworth, Jill V. Hunter, Ana M. Sánchez, Dina Tiniakos, Derek A. Mann, Fiona Oakley, Neil D. Perkins
Издательство: Lippincott Williams & Wilkins
Источник: Hepatology
Ключевые слова: Lung Cancer Treatments and Mutations
Открытый доступ: bronze
Том: 62
Выпуск: S1
Страницы: 531A–543A