Relationship of HRQL to Treatment Adherence and SVR in CHC Patients -- Hepatitis C Outreach Project

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Subject: Relationship of HRQL to Treatment Adherence and SVR in CHC Patients

Author:
David Bernstein (HEPATOLOGY 2002;35:704-708.)

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Date Posted: Sun, August 11 2002, 5:38:49 PDT
In reply to: H. Aaron Aronow,MD Neurology and Internal Medicine USC .. 's message, "Neurological manifestation of HCV" on Sat, May 19 2001, 10:27:06 PDT

Relationship of Health-Related Quality of Life to
Treatment Adherence and Sustained Response in Chronic
Hepatitis C Patients

David Bernstein,1 Leah Kleinman,2 Chris M. Barker,3 Dennis A. Revicki,2 and Jesse Green 4

Interferon therapy may exacerbate health-related quality of life (HRQL) deficits associated with hepatitis C virus (HCV) early in the course of therapy. Treatment with polyethylene glycol�modified interferon (peginterferon) alfa-2a (40 kd) provides improved sustained
response over interferon alfa-2a, but its effect on HRQL is unknown. The objective of this study was to (1) evaluate the effect of sustained virologic response on HRQL in patients with
HCV and (2) determine whether impairment of HRQLduring treatment contributes to early
treatment discontinuation.

Data consisted of a pooled secondary analysis of patients (n 51,441) across 3 international, multicenter, open-label, randomized studies that compared
peginterferon alfa-2a (40 kd) with interferon alfa-2a. ANCOVA was used to examine the
effect of sustained virologic response on HRQL. Repeated-measures mixed-models
ANCOVA was used to compare Fatigue Severity Scale (FSS) and SF-36 scores during treat-ment
by treatment group.

Logistic regression analysis was used to examine the association
between changes at baseline in on-treatment HRQL and early treatment discontinuation.

Sustained virologic response was associated with marked improvements from baseline to end
of follow-up in all subjects, including patients with cirrhosis. During treatment, patients
receiving peginterferon alfa-2a (40 kd) had statistically significantly better scores on both the
SF-36 and FSS. Baseline to 24-week changes in fatigue and SF-36 mental and physical
summary scores significantly predicted treatment discontinuation.

In conclusion, sustained
virologic response is associated with improvements in quality of life in patients with or
without advanced liver disease. This parameter may be an important consideration in max-imizing
treatment adherence. (HEPATOLOGY 2002;35:704-708.)

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Replies:

Subject	Author	Date
Central nervous system involvement in patients with hepatitis C infection	Rev Neurol (Paris) 2002 Dec;158(12):1202-4	Thu, January 02 2003, 19:20:55 PST