Fang Yu, Chen Chung-Yu, Yu Hsien-Chung, Lin Pei-Chin
Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Pharmacy, Pingtung Veterans General Hospital, Pingtung, Taiwan.
Front Pharmacol. 2023 Jul 19;14:1191843. doi: 10.3389/fphar.2023.1191843. eCollection 2023.
Data on the neuropsychological outcomes after receiving direct-acting antivirals (DAAs) among chronic hepatitis C (CHC) patients have not been well-documented. This study aimed to evaluate the difference in incidence of neuropsychological disorders (NPDs) after treatment completion between CHC patients receiving interferon (IFN) therapy and DAA therapy. A nationwide retrospective cohort study was performed using Taiwan's National Health Insurance Research Database (NHIRD) between 2010 and 2018. CHC patients without pre-existing mental disorders were included and divided into the treatment (Tx)-naïve DAA group, retreatment (re-Tx) DAA group, and Tx-naïve IFN group based on their HCV therapy. Propensity score matching was used to balance baseline differences between groups. The primary outcome was the incidence of NPDs during 6 months after completion of therapy. After one-to-one matching, there were 6,461 pairs of patients selected from the Tx-naïve DAA group and Tx-naïve IFN group and 3,792 pairs from the re-Tx DAA group and Tx-naïve IFN group. A lower incidence of NPDs was observed in the Tx-naïve DAA group than in the Tx-naïve IFN group (HR = 0.72, 95% CI = 0.55-0.94, and = 0.017). The risk of NPDs did not differ between the re-Tx DAA group and the Tx-naïve IFN group (HR = 0.74, 95% CI: 0.52-1.05, and = 0.092). DAA therapy was associated with lower risk of NPDs when compared with IFN therapy among Tx-naïve CHC patients in a 6-month period after treatment completion, especially among the patients less than 65 years, male gender, and cirrhosis.
慢性丙型肝炎（CHC）患者接受直接作用抗病毒药物（DAA）治疗后的神经心理学转归数据尚无充分记录。本研究旨在评估接受干扰素（IFN）治疗和DAA治疗的CHC患者在治疗结束后神经心理障碍（NPD）发生率的差异。利用台湾地区国民健康保险研究数据库（NHIRD）在2010年至2018年期间进行了一项全国性回顾性队列研究。纳入无既往精神障碍的CHC患者，并根据其丙型肝炎病毒（HCV）治疗情况分为初治DAA组、复治DAA组和初治IFN组。采用倾向评分匹配法平衡组间基线差异。主要结局为治疗结束后6个月内NPD的发生率。经过一对一匹配，从初治DAA组和初治IFN组中选取了6461对患者，从复治DAA组和初治IFN组中选取了3792对患者。初治DAA组的NPD发生率低于初治IFN组（风险比[HR]=0.72，95%置信区间[CI]=0.55-0.94，P=0.017）。复治DAA组和初治IFN组之间NPD的风险无差异（HR=0.74，95%CI：0.52-1.05，P=0.092）。在治疗结束后的6个月内，与IFN治疗相比，DAA治疗与初治CHC患者发生NPD的风险较低相关，尤其是在年龄小于65岁、男性和肝硬化患者中。
