Author:
Scripps Clin, La Jolla, CA
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Date Posted: Sat, March 03 2001, 7:47:00 PST
In reply to:
Yngve T Falck-Ytter, Steedman A Sarbah, et al
's message, "SURPRISINGLY LOW IMPACT OF INTERFERON ON HEPATITIS C PATIENTS ........" on Sat, March 03 2001, 6:56:32 PST
HOW OFTEN ARE REFERRED CHRONIC HEPATITIS C PATIENTS CANDIDATES FOR ANTIVIRAL THERAPY?
Javaid Shad, Scripps Clin and Research Fdn, La Jolla, CA; John Person, Sharp-Rees-Steely Medical Ctr, San Diego, CA; Oscar Brann, Naval Medical Ctr, San Diego, CA; Scott Moon, Scripps Clin and Research Fdn, La Jolla, CA; Paul J Pockros, Scripps Clin, La Jolla, CA; L Nyberg, Scripps Clin and Research Fdn, La Jolla, CA; Stephen Pianko, J G McHutchison, Scripps Clin, La Jolla, CA
Background:The proportion of patients with chronic hepatitis C virus infection that are eligible for therapy with interferon plus ribavirin or interferon monotherapy is unknown. Also, the reasons for not offering therapy have not been studied prospectively.
Aims:To assess the proportion of patients referred for treatment of hepatitis C who are candidates for therapy; and to evaluate the major contraindications to therapy. Methods: 344 patients referred for initial treatment and evaluation of chronic hepatitis C were screened prospectively at three different medical facilities including a community based private gastroenterology practice, a military medical center, and a tertiary referral center. These patients were evaluated for their suitability for treatment with interferon plus ribavirin and/or interferon monotherapy. If they were not candidates for therapy, the reasons for their disqualification were noted using a standardized form that was evaluated centrally.
Results:Overall, only 58% of patients were candidates for therapy. Of these patients, 98% were candidates for combination therapy. There were significant differences at the three different medical facilities with 34% of patients considered candidates for therapy at a community based private gastroenterology practice as compared to 64% and 81% of patients considered candidates for therapy at a tertiary referral center and a military medical center respectively.
The predominant reason for not being offered therapy was a persistently normal ALT in 25% of patients.
Other common reasons for not being offered therapy included active alcohol use (17%), depression (17%), and patient's unwillingness to undergo current anti-viral therapy (12%). Conclusions:Slightly more than half of the patients studied were considered suitable candidates for therapy, and of these, the majority were candidates for interferon plus ribavirin combination therapy. The proportion of patients considered suitable for therapy also depended on the institution where the evaluation took place. Common reasons for not offering therapy included normal ALT values, alcohol use, depression and unwillingness to undergo treatment.
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