Z Gastroenterol 2012; 50 - P4_38
DOI: 10.1055/s-0031-1295924

Comparison of therapy outcome of patients with drug addiction (DA) versus patients with former iv drug use (IVDU) treated with Peginterferon alfa–2a/Ribavirin in real life setting

S Mauss 1, D Hüppe 2, T Lutz 3, A Schober 4, G Moog 5, KH Hey 6, W Schiffelholz 7, G Teuber 8, A Baumgarten 9, W Schmidt 10, A Stoehr 11, M Waizmann 12, K Isernhagen 13, U Alshuth 14, P Buggisch 11
  • 1Center for HIV and Hepatogastroenterology, Düsseldorf
  • 2Gastroenterologische Gemeinschaftspraxis, Herne
  • 3Infektiologikum, Frankfurt/M
  • 4Gastroenterologische Praxis, Göttingen
  • 5Gastroenterologische Praxis, Kassel
  • 6Gemeinschaftsideals DM. K.-H.Hey/ Dr.med. K.D. Krenzel, Paderborn
  • 7Gastroenterologische Praxis, Augsburg
  • 8Interdisziplinäres Facharztzentrum Sachsenhausen, Frankfurt/M
  • 9mib Dienstleistungs GmbH, Berlin
  • 10Ärzteforum Seestraße, Berlin
  • 11ifi – Institut für Interdisziplinäre Medizin Asklepios Klinik St. Georg, Hamburg
  • 12Gemeinschaftspraxis, Leipzig
  • 13Praxis für Allgemeinmedizin, Köln
  • 14Roche Pharma AG, Grenzach

Aims: Small clinical trials showed that pts with former IVDU achieved lower SVR rates than patients under drug addiction. These results were explained by higher adherence and lower drop out rates of methadone substituted pts.

Methods: From January 2008 to February 2011, 3793 patients with chronic HCV were documented in a German-wide non-interventional study (bng/Roche). 924 naive patients with completed documentation were stratified according to their history of former iv drug use (N=392) or recent drug addiction (N=532) during treatment against HCV.

Results: Main baseline-characteristics of the population: age 37.1 y, 75.2% male, BMI 24.8kg/m2, mean duration of infection 10.2 years, GT–1/4/5/6 (GT–1) 48.1%, GT 2/3 (G–2/3) 51.9%, 55.9% high viral load (≥ 400.000 IU/ml). Mean duration of HCV treatment was 37.5 vs. 33.9 weeks in GT–1 and 24.4 vs. 23.2 weeks in GT–2/3 in drug addicted vs. former IVDU pts. Compliance (judged by physician) was comparable in all groups.Overall, SVR was achieved in 50.2% pts. (44.1% GT–1 vs. 55.8% GT–2/3). Observed SVR in GT–1 pts was 45.7% vs. 42.1% (DA vs. IVDU) and in GT–2/3 pts. 56.6% vs. 55.0% (DA vs. IVDU). Treatment discontinuation occured in 36.6% GT–1 and 25.9% GT–2/3 DA pts. and in 42.6% GT–1 and 23.3% GT–2/3 IVDU pts. Reasons of treatment discontinuations are shown in the table.

Conclusion: These data showed that treatment discontinuations due to patient wish and rate of lost to follow-up are higher in pts with former IVDU than in recently drug addicted pts. So treatment of HCV is strictly to recommend in pts with drug addiction. Whether supporting measures like psychoeducation can further increase success rates isunder evaluation.

Table: Reasons of treatment discontinuation

Drug addiction

Former IVDU

Discontinuation due to

GT 1/4/5/6

GT 2/3

GT 1/4/5/6

GT 2/3

Virological Nonresponse

11,8%

2,5%

13,2%

0,5%

Poor tolerability

3,9%

5,4%

1,6%

3,0%

Lack of compliance

4,3%

4,3%

5,8%

5,9%

Patient wish

5,1%

8,6%

4,7%

3,5%

Lost to follow-up

10,6%

8,3%

18,4%

12,9%