Phase 4
Completed N=350
Hepatitis C Treatment in PWIDs: MAT or Syringe Exchange Assisted-therapy vs Standard of Care
Hepatitis C · Substance Use Disorder · Substance Abuse, Intravenous
Source: ClinicalTrials.gov NCT03093415 ↗
Enrolled (actual)
350
Serious AEs
2.0%
Results posted
Nov 2020
Primary outcomePrimary: SVR 12 — 24; 15; 47; 1 Participants
◆ Published Evidence
Highly cited
313citations · ~24 / year
Treatment of hepatitis C virus infection among people who are actively injecting drugs: a systematic review and meta-analysis.
Summary
hepatitis C virus (HCV) has traditionally been treated in subspecialty health centers given the complexity of older pegylated interferon containing regimens, formerly the standard of care. This model has persisted into the modern era of direct anti-viral agents (DAAs) despite their relative simplicity, creating a bottleneck of human resources necessary to fight the largest infectious epidemic in North America. In addition, stigma and fear over cost has lead payers to restrict treatment in People Who Inject Drugs (PWIDs), even though a majority of new infections occur in this population.
This study evaluates the effectiveness of treatment of HCV with elbasvir-grasoprevir in PWIDs in a real world, community health clinic setting.
There are two prospective cohorts of PWIDs of 25 patients each, both in primary care-based community health clinics in Portland, Oregon. Cohort one is actively engaged with ambulatory medication assisted therapy with buprenorphine or extended released injectable naltrexone. Cohort two maintains active injection drug use with needle exchange and risk reduction education.
These groups are compared to a 50 patient retrospective cohort of people with substance use disorders at tertiary care hepatology-based treatment program.
All patients have genotype 1 or 4 HCV and are treated with elbasvir-grasoprevir for 12 weeks.
The investigators hypothesize there is no difference in sustained viremic response at 12 or 48 weeks post-completion of treatment (SVR 12, 48) when treating patients in a community health clinic setting as compared to the standard-of-care subspecialty setting.
Linked Publications (5)
-
Treatment of hepatitis C virus infection among people who are actively injecting drugs: a systematic review and meta-analysis.
-
Models of care for the management of hepatitis C virus among people who inject drugs: one size does not fit all.
-
Optimizing assessment and treatment for hepatitis C virus infection in illicit drug users: a novel model incorporating multidisciplinary care and peer support.
-
The impact of barriers to hepatitis C virus treatment in recovering heroin users maintained on methadone.
-
Treatment of chronic hepatitis C infection among current and former injection drug users within a multidisciplinary treatment model at a community health centre.
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY SVR 12 |
24; 15; 47; 1; 10; 3 | — |
| SECONDARY SVR 48 |
17; 3; 0; 0; 4; 0 | — |
| SECONDARY Discontinuation Rate or Lost To Follow Up |
24; 16; 47; 1; 9; 3 | — |
| SECONDARY NS5A Resistance |
5; 3; 0; 160; 132; 0 | — |
| SECONDARY Medication Adherence |
0; 8; 0; 2; 0; 0 | — |
| SECONDARY Injection Drug Use Relapse (IDU) |
— | — |
Eligibility Criteria
Inclusion Criteria
- Genotype 1b and genotype 1a without baseline NS5A resistance or Genotype 4
- APRI Score 0.7 a Fibrosure/Fibrotest or Fibroscan score of F2 or less
- No clinical or laboratory evidence of cirrhosis
- Readiness for treatment based on ability to make >2/3 sequential office visits
- Patients must be assessed to have decision-making capacity, be capable of consenting, and not be displaying evidence of overt intoxication.
Exclusion Criteria
- Clinical or Laboratory Evidence of Cirrhosis
- Elevated prothrombin time unrelated to anticoagulation, hemoglobin level less than 12.3 g/L in females and <14 g/L in males, platelet count <150 × 109 cells/L), white blood cells (WBC) <4.0 x103/mm3 , aminotransferase levels more than 10 times the upper limit of normal, or albumin level <3.5 g/L.
- Previous treatment for hepatitis C infection
- Hepatocellular carcinoma
- HIV or hepatitis B virus co-infection
- Subjects taking medications that are contra-indicated to administer with Zepatier including phenytoin, carbamazepine, rifampin, St. John's Wort, and cyclosporine AND unable to change these medications to one without interactions.
Data sourced from ClinicalTrials.gov (NCT03093415) and the linked publication. Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication. Informational only — not medical advice.