Kumthekar Anand, Shull Sarah, Lovejoy Travis I, Morasco Benjamin J, Chang Michael, Barton Jennifer
Montefiore Medical Center, Albert Einstein College of Medicine, New York.
Oregon Health and Science University, Portland, Oregon.
Int J Rheum Dis. 2019 Apr;22(4):592-598. doi: 10.1111/1756-185X.13479. Epub 2019 Feb 6.
To assess the impact of direct acting anti-viral (DAA) therapy for hepatitis C virus (HCV) infection on changes in pain intensity and prescription opioid use among Veterans.
We conducted a retrospective cohort study of Veterans with HCV who were seen in a rheumatology clinic at least once while receiving DAA therapy between January 1, 2010 and December 31st 2016. Demographic characteristics, HCV status, HCV treatment characteristics, numeric rating scale (NRS) pain scores and opioid prescription data were extracted from the electronic medical record. Pain scores were averaged over 6 months prior to HCV treatment and 6 months after completion of treatment. Prescription opioid dose was converted to a morphine equivalent daily dose (MEDD) and averaged across the two 6-month intervals. Generalized estimating equations were used to model the change in average pain and MEDD from pre- to post-HCV treatment. Effect size was assessed using Cohen's d.
A total of 121 Veterans, 91% male with average age of 59 were included. Average pre-treatment pain was 4.4 (SD 2.4). The average reduction in pain scores was 0.6 points (P = 0.02, Cohen's d = 0.22) after treatment. Among 67 patients prescribed chronic opioid therapy at baseline, average pre-treatment MEDD was 52.4 mg (SD = 62.5 mg) and post-DAA treatment average MEDD was 49.5 mg (SD = 69.3 mg), representing a decrease by 2.9 mg (P < 0.01, Cohen's d = 0.14). Opioid dose reduction was seen in 43/67 patients and 12 patients discontinued opioids entirely.
Among US Veterans, subjective pain scores had modest improvement and opioid prescriptions were mildly reduced following treatment with DAA.
评估直接抗病毒（DAA）疗法治疗丙型肝炎病毒（HCV）感染对退伍军人疼痛强度变化和阿片类药物处方使用情况的影响。
我们对2010年1月1日至2016年12月31日期间在风湿病诊所接受DAA治疗时至少就诊过一次的HCV退伍军人进行了一项回顾性队列研究。从电子病历中提取人口统计学特征、HCV状态、HCV治疗特征、数字评分量表（NRS）疼痛评分和阿片类药物处方数据。疼痛评分在HCV治疗前6个月和治疗完成后6个月进行平均。将阿片类药物处方剂量转换为吗啡等效日剂量（MEDD），并在两个6个月的时间段内进行平均。使用广义估计方程对HCV治疗前后平均疼痛和MEDD的变化进行建模。使用科恩d值评估效应大小。
共纳入121名退伍军人，其中91%为男性，平均年龄59岁。治疗前平均疼痛评分为4.4（标准差2.4）。治疗后疼痛评分平均降低0.6分（P = 0.02，科恩d值 = 0.22）。在基线时开具慢性阿片类药物治疗的67名患者中，治疗前平均MEDD为52.4毫克（标准差 = 62.5毫克），DAA治疗后平均MEDD为49.5毫克（标准差 = 69.3毫克），减少了2.9毫克（P < 0.01，科恩d值 = 0.14）。43/67名患者的阿片类药物剂量减少，12名患者完全停用阿片类药物。
在美国退伍军人中，接受DAA治疗后主观疼痛评分有适度改善，阿片类药物处方量略有减少。
