Absolute and relative contraindications to pegylated-interferon or ribavirin in the US general patient population with chronic hepatitis C

Results from a US database of over 45 000 HCV-infected, evaluated patients

A. H. Talal, J. Lafleur, R. Hoop, P. Pandya, Paul Martin, I. Jacobson, J. Han, E. J. Korner

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background Chronic hepatitis C (HCV) treatment with pegylated-interferon (PEG-IFN)/ribavirin (RBV) is often limited by preexisting medical, psychiatric and psychosocial contraindications. However, limited data exist in general patient populations. Aim To evaluate the percentage of HCV-infected patients in the general US population who may have contraindications to PEG-IFN/RBV. Methods The General Electric (GE) Centricity dataset was used to screen the US population between 2004 and 2009 for HCV infection and contraindications to PEG-IFN/RBV. HCV diagnosis and contraindications were identified using ICD-9-CM codes or laboratory values. Only patients with an encounter 180 days prior to HCV diagnosis were included. Demographic differences were calculated using Pearson's chi-squared test. Frequencies and percentages for absolute and relative contraindications to PEG-IFN and/or RBV were determined and proportions and rates/1000 person-months were calculated. Results A total of 15 561 021 patients were screened, and 45 690 (0.3%) were HCV-positive and were evaluated. Those with contraindications were significantly younger, female, White, not currently married and receiving Medicare or Medicaid coverage (all P < 0.0001). 17.3% had at least one contraindication to PEG-IFN/RBV (5.5 events/1000 person-months); bipolar disorder (6.5%), anaemia (Hgb < 10 g/dL; 5.9%), pregnancy (1.9%) and neutropenia (neutrophils <750 cells/mm3; 1.2%) were most frequently cited. Conclusions Approximately, 17% of HCV-infected patients in the general US population had at least one contraindication to PEG-IFN/RBV. Most contraindications were relative and potentially modifiable. Clinical assessment of contraindications as relative and/or modifiable should be considered and used to determine if patients could benefit from current PEG-IFN-containing triple therapy or future PEG-IFN- or RBV-free regimens.

Original languageEnglish
Pages (from-to)473-481
Number of pages9
JournalAlimentary Pharmacology and Therapeutics
Volume37
Issue number4
DOIs
StatePublished - Feb 1 2013

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Ribavirin
Chronic Hepatitis C
Interferons
Databases
Population
Medicaid
International Classification of Diseases
Medicare
Neutropenia
Bipolar Disorder
Psychiatry
Anemia
Neutrophils
Demography
Pregnancy
Therapeutics
Infection

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Absolute and relative contraindications to pegylated-interferon or ribavirin in the US general patient population with chronic hepatitis C : Results from a US database of over 45 000 HCV-infected, evaluated patients. / Talal, A. H.; Lafleur, J.; Hoop, R.; Pandya, P.; Martin, Paul; Jacobson, I.; Han, J.; Korner, E. J.

In: Alimentary Pharmacology and Therapeutics, Vol. 37, No. 4, 01.02.2013, p. 473-481.

Research output: Contribution to journalArticle

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title = "Absolute and relative contraindications to pegylated-interferon or ribavirin in the US general patient population with chronic hepatitis C: Results from a US database of over 45 000 HCV-infected, evaluated patients",
abstract = "Background Chronic hepatitis C (HCV) treatment with pegylated-interferon (PEG-IFN)/ribavirin (RBV) is often limited by preexisting medical, psychiatric and psychosocial contraindications. However, limited data exist in general patient populations. Aim To evaluate the percentage of HCV-infected patients in the general US population who may have contraindications to PEG-IFN/RBV. Methods The General Electric (GE) Centricity dataset was used to screen the US population between 2004 and 2009 for HCV infection and contraindications to PEG-IFN/RBV. HCV diagnosis and contraindications were identified using ICD-9-CM codes or laboratory values. Only patients with an encounter 180 days prior to HCV diagnosis were included. Demographic differences were calculated using Pearson's chi-squared test. Frequencies and percentages for absolute and relative contraindications to PEG-IFN and/or RBV were determined and proportions and rates/1000 person-months were calculated. Results A total of 15 561 021 patients were screened, and 45 690 (0.3{\%}) were HCV-positive and were evaluated. Those with contraindications were significantly younger, female, White, not currently married and receiving Medicare or Medicaid coverage (all P < 0.0001). 17.3{\%} had at least one contraindication to PEG-IFN/RBV (5.5 events/1000 person-months); bipolar disorder (6.5{\%}), anaemia (Hgb < 10 g/dL; 5.9{\%}), pregnancy (1.9{\%}) and neutropenia (neutrophils <750 cells/mm3; 1.2{\%}) were most frequently cited. Conclusions Approximately, 17{\%} of HCV-infected patients in the general US population had at least one contraindication to PEG-IFN/RBV. Most contraindications were relative and potentially modifiable. Clinical assessment of contraindications as relative and/or modifiable should be considered and used to determine if patients could benefit from current PEG-IFN-containing triple therapy or future PEG-IFN- or RBV-free regimens.",
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T1 - Absolute and relative contraindications to pegylated-interferon or ribavirin in the US general patient population with chronic hepatitis C

T2 - Results from a US database of over 45 000 HCV-infected, evaluated patients

AU - Talal, A. H.

AU - Lafleur, J.

AU - Hoop, R.

AU - Pandya, P.

AU - Martin, Paul

AU - Jacobson, I.

AU - Han, J.

AU - Korner, E. J.

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N2 - Background Chronic hepatitis C (HCV) treatment with pegylated-interferon (PEG-IFN)/ribavirin (RBV) is often limited by preexisting medical, psychiatric and psychosocial contraindications. However, limited data exist in general patient populations. Aim To evaluate the percentage of HCV-infected patients in the general US population who may have contraindications to PEG-IFN/RBV. Methods The General Electric (GE) Centricity dataset was used to screen the US population between 2004 and 2009 for HCV infection and contraindications to PEG-IFN/RBV. HCV diagnosis and contraindications were identified using ICD-9-CM codes or laboratory values. Only patients with an encounter 180 days prior to HCV diagnosis were included. Demographic differences were calculated using Pearson's chi-squared test. Frequencies and percentages for absolute and relative contraindications to PEG-IFN and/or RBV were determined and proportions and rates/1000 person-months were calculated. Results A total of 15 561 021 patients were screened, and 45 690 (0.3%) were HCV-positive and were evaluated. Those with contraindications were significantly younger, female, White, not currently married and receiving Medicare or Medicaid coverage (all P < 0.0001). 17.3% had at least one contraindication to PEG-IFN/RBV (5.5 events/1000 person-months); bipolar disorder (6.5%), anaemia (Hgb < 10 g/dL; 5.9%), pregnancy (1.9%) and neutropenia (neutrophils <750 cells/mm3; 1.2%) were most frequently cited. Conclusions Approximately, 17% of HCV-infected patients in the general US population had at least one contraindication to PEG-IFN/RBV. Most contraindications were relative and potentially modifiable. Clinical assessment of contraindications as relative and/or modifiable should be considered and used to determine if patients could benefit from current PEG-IFN-containing triple therapy or future PEG-IFN- or RBV-free regimens.

AB - Background Chronic hepatitis C (HCV) treatment with pegylated-interferon (PEG-IFN)/ribavirin (RBV) is often limited by preexisting medical, psychiatric and psychosocial contraindications. However, limited data exist in general patient populations. Aim To evaluate the percentage of HCV-infected patients in the general US population who may have contraindications to PEG-IFN/RBV. Methods The General Electric (GE) Centricity dataset was used to screen the US population between 2004 and 2009 for HCV infection and contraindications to PEG-IFN/RBV. HCV diagnosis and contraindications were identified using ICD-9-CM codes or laboratory values. Only patients with an encounter 180 days prior to HCV diagnosis were included. Demographic differences were calculated using Pearson's chi-squared test. Frequencies and percentages for absolute and relative contraindications to PEG-IFN and/or RBV were determined and proportions and rates/1000 person-months were calculated. Results A total of 15 561 021 patients were screened, and 45 690 (0.3%) were HCV-positive and were evaluated. Those with contraindications were significantly younger, female, White, not currently married and receiving Medicare or Medicaid coverage (all P < 0.0001). 17.3% had at least one contraindication to PEG-IFN/RBV (5.5 events/1000 person-months); bipolar disorder (6.5%), anaemia (Hgb < 10 g/dL; 5.9%), pregnancy (1.9%) and neutropenia (neutrophils <750 cells/mm3; 1.2%) were most frequently cited. Conclusions Approximately, 17% of HCV-infected patients in the general US population had at least one contraindication to PEG-IFN/RBV. Most contraindications were relative and potentially modifiable. Clinical assessment of contraindications as relative and/or modifiable should be considered and used to determine if patients could benefit from current PEG-IFN-containing triple therapy or future PEG-IFN- or RBV-free regimens.

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