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慢性丙型肝炎病毒感染患者持续病毒学应答对患者报告结局的长期益处。

Long-term Benefits of Sustained Virologic Response for Patient-Reported Outcomes in Patients With Chronic Hepatitis C Virus Infection.

作者信息

Younossi Zobair M, Stepanova Maria, Racila Andrei, Afendy Arian, Lawitz Eric J, Schwabe Christian, Ruane Peter J, Lalezari Jay, Reddy K Rajender, Jacobson Ira M, Muir Andrew J, Gaggar Anuj, Myers Robert P, Younossi Issah, Nader Fatema

机构信息

Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.

Center for Outcomes Research in Liver Disease, Washington, District of Columbia.

出版信息

Clin Gastroenterol Hepatol. 2020 Feb;18(2):468-476.e11. doi: 10.1016/j.cgh.2019.07.047. Epub 2019 Jul 31.

Abstract

BACKGROUND & AIMS: Patients with hepatitis C virus (HCV) infections who achieve a sustained virologic response (SVR) to treatment have improved patient-reported outcomes (PROs). We compared post-treatment PRO scores between patients with chronic HCV infection who did and did not achieve an SVR to treatment.

METHODS

Patients who completed treatment in clinical trials were enrolled in 2 registries, depending on the treatment outcome (NCT01457755, NCT01457768), from 2016 to 2017 in 17 countries in North America, Europe, and the Asia-Pacific region. PRO scores (scale, 0-100) were collected at pretreatment (baseline); the last day of treatment; the post-treatment week 12 follow-up visit (in patients with SVR only); the registry baseline; and on registry weeks 12, 24, 36, 48, and 96 (the non-SVR registry) or every 24 weeks until week 96 (SVR registry), using the Short Form-36 (SF-36) instrument.

RESULTS

Our analysis included 4234 patients with an SVR and 242 without an SVR from whom pretreatment PRO data were available (mean age, 54 ± 10 y; 63% male; 65% enrolled in the United States; 17% with cirrhosis; 12% with human immunodeficiency virus co-infection). Upon registry enrollment, patients with an SVR had significant increases in all PRO scores compared with pretreatment baseline levels (all P < .05). Patients without an SVR had mean reductions of 9.2 points or less in PRO scores while followed up on the registry (P < .05 for 4-8 of 8 PRO domains measured by the SF-36). In contrast, patients with an SVR had sustained increases in PRO scores (mean increase, ≤7.0 points) while on the registry. In multivariate analysis, achieving an SVR was associated independently with superior scores in all SF-36 domains at all registry time points (β, +4.8 to +15.9 points, all P ≤ .01).

CONCLUSIONS

In a follow-up analysis of participants in clinical trials, we found that those with an SVR to treatment for HCV infection had significant increases in well-being, based on PRO scores. Patients without an SVR had decreasing PRO scores over the follow-up period.

摘要

背景与目的

对丙型肝炎病毒(HCV)感染治疗获得持续病毒学应答(SVR)的患者,其患者报告结局(PRO)有所改善。我们比较了慢性HCV感染患者中治疗获得和未获得SVR者的治疗后PRO评分。

方法

2016年至2017年期间,在北美、欧洲和亚太地区的17个国家,根据治疗结局(NCT01457755、NCT01457768)将在临床试验中完成治疗的患者纳入2个注册登记处。使用简明健康调查量表(SF-36)在治疗前(基线)、治疗最后一天、治疗后第12周随访(仅针对获得SVR的患者)、注册登记处基线以及注册登记处第12、24、36、48和96周(未获得SVR的注册登记处)或直至第96周每24周(获得SVR的注册登记处)收集PRO评分(范围0-100)。

结果

我们的分析纳入了4234例获得SVR的患者和242例未获得SVR的患者,这些患者有治疗前PRO数据(平均年龄54±10岁;63%为男性;美国入组患者占65%;17%有肝硬化;12%合并人类免疫缺陷病毒感染)。在注册登记时,与治疗前基线水平相比,获得SVR的患者所有PRO评分均显著升高(均P<.05)。未获得SVR的患者在注册登记随访期间PRO评分平均降低9.2分或更低(SF-36测量的8个PRO领域中有4-8个P<.05)。相比之下,获得SVR的患者在注册登记期间PRO评分持续升高(平均升高≤7.0分)。在多变量分析中,在所有注册登记时间点,获得SVR均与所有SF-36领域的更高评分独立相关(β值为+4.8至+15.9分,均P≤.01)。

结论

在对临床试验参与者的随访分析中,我们发现,基于PRO评分,HCV感染治疗获得SVR的患者幸福感显著提高。未获得SVR的患者在随访期间PRO评分下降。

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