Racial differences in hepatitis C treatment eligibility

[Guest guest]

Hepatology. 2011 Apr 12. doi: 10.1002/hep.24358. [Epub ahead of print]

Racial differences in hepatitis C treatment eligibility.

Melia MT, Muir AJ, McCone J, Shiffman ML, King JW, Herrine SK, Galler GW,

Bloomer JR, Nunes FA, Brown KA, Mullen KD, Ravendhran N, Ghalib RH, Boparai N,

Jiang R, Noviello S, Brass CA, Albrecht JK, McHutchison JG, Sulkowski MS; on

behalf of the IDEAL Study Team.

s Hopkins University School of Medicine, Duke University. mmelia4@....

Abstract

BACKGROUND AND RATIONALE: Black Americans are disproportionally infected with

hepatitis C virus (HCV) and are less likely than whites to respond to treatment

with peginterferon (PEG- IFN) plus ribavirin (RBV). The impact of race on HCV

treatment eligibility is unknown. We therefore performed a retrospective

analysis of a phase 3B multicenter clinical trial conducted at 118 United States

community and academic medical centers to evaluate the rates of and reasons for

HCV treatment ineligibility according to self- reported race.

MAIN RESULTS: 4469 patients were screened, of whom 1038 (23.2%) were treatment

ineligible. While blacks represented 19% of treated patients, they were more

likely not to be treated due to ineligibility and/or failure to complete

required evaluations (40.2%) than were nonblack patients (28.5%; P<.001). After

the exclusion of persons not treated due to undetectable HCV RNA or non-genotype

1 infection, blacks were 65% less likely than nonblacks to be eligible for

treatment (28.1% > 17.0%; relative risk, 1.65; 95% confidence interval, 1.46-

1.87; P<.001). Blacks were more likely to be ineligible due to neutropenia (14%

vs 3%, P<.001), anemia (7% vs 4%, P=.02), elevated glucose (8% vs 3%, P<.001),

and elevated creatinine (5% vs 1%, P<.001).

CONCLUSIONS: Largely due to a higher prevalence of neutropenia and uncontrolled

medical conditions, blacks were significantly less likely to be eligible for HCV

treatment. Increased access to treatment may be facilitated by less conservative

neutrophil requirements and more effective care for chronic diseases, namely

diabetes and renal insufficiency. (HEPATOLOGY 2011.).

Copyright © 2011 American Association for the Study of Liver Diseases.

PMID: 21488082 [PubMed - as supplied by publisher]

[Guest guest]

Hepatology. 2011 Apr 12. doi: 10.1002/hep.24358. [Epub ahead of print]

Racial differences in hepatitis C treatment eligibility.

Melia MT, Muir AJ, McCone J, Shiffman ML, King JW, Herrine SK, Galler GW,

Bloomer JR, Nunes FA, Brown KA, Mullen KD, Ravendhran N, Ghalib RH, Boparai N,

Jiang R, Noviello S, Brass CA, Albrecht JK, McHutchison JG, Sulkowski MS; on

behalf of the IDEAL Study Team.

s Hopkins University School of Medicine, Duke University. mmelia4@....

Abstract

BACKGROUND AND RATIONALE: Black Americans are disproportionally infected with

hepatitis C virus (HCV) and are less likely than whites to respond to treatment

with peginterferon (PEG- IFN) plus ribavirin (RBV). The impact of race on HCV

treatment eligibility is unknown. We therefore performed a retrospective

analysis of a phase 3B multicenter clinical trial conducted at 118 United States

community and academic medical centers to evaluate the rates of and reasons for

HCV treatment ineligibility according to self- reported race.

MAIN RESULTS: 4469 patients were screened, of whom 1038 (23.2%) were treatment

ineligible. While blacks represented 19% of treated patients, they were more

likely not to be treated due to ineligibility and/or failure to complete

required evaluations (40.2%) than were nonblack patients (28.5%; P<.001). After

the exclusion of persons not treated due to undetectable HCV RNA or non-genotype

1 infection, blacks were 65% less likely than nonblacks to be eligible for

treatment (28.1% > 17.0%; relative risk, 1.65; 95% confidence interval, 1.46-

1.87; P<.001). Blacks were more likely to be ineligible due to neutropenia (14%

vs 3%, P<.001), anemia (7% vs 4%, P=.02), elevated glucose (8% vs 3%, P<.001),

and elevated creatinine (5% vs 1%, P<.001).

CONCLUSIONS: Largely due to a higher prevalence of neutropenia and uncontrolled

medical conditions, blacks were significantly less likely to be eligible for HCV

treatment. Increased access to treatment may be facilitated by less conservative

neutrophil requirements and more effective care for chronic diseases, namely

diabetes and renal insufficiency. (HEPATOLOGY 2011.).

Copyright © 2011 American Association for the Study of Liver Diseases.

PMID: 21488082 [PubMed - as supplied by publisher]