High Risk of Infection During Triple Therapy with First-Generation Protease Inhibitors: A Nationwide Cohort Study

被引:3
作者
Berden, Floor A. C. [1 ]
van Zwietering, Inke M. J. M. [1 ]
Maan, Raoel [2 ]
de Knegt, Robert J. [2 ]
Kievit, Wietske [3 ]
Drenth, Joost P. H. [1 ]
机构
[1] Radboud Univ Nijmegen, Med Ctr, Dept Gastroenterol & Hepatol, POB 9101,Code 455, NL-6500 HB Nijmegen, Netherlands
[2] Erasmus MC Univ, Med Ctr, Dept Gastroenterol & Hepatol, Rotterdam, Netherlands
[3] Radboud Univ Nijmegen, Med Ctr, Dept Hlth Evidence, NL-6500 HB Nijmegen, Netherlands
关键词
antiviral agents; boceprevir; telaprevir; hepatitis C infection; neutropenia; risk factors; CHRONIC HEPATITIS-C; GENOTYPE; INFECTION; TREATMENT-EXPERIENCED PATIENTS; PEGYLATED INTERFERON-ALPHA; VIRUS-INFECTION; DIABETES-MELLITUS; ADVANCED FIBROSIS; ACCESS PROGRAM; BOCEPREVIR; CIRRHOSIS;
D O I
10.15403/jgld.2014.1121.252.th3
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: Peginterferon (PegIFN) remains the backbone of therapy for chronic hepatitis C (CHC) in economically constrained regions. However, PegIFN may cause neutropenia and addition of a protease inhibitor can increase the likelihood of neutropenia. The aims of this study were to assess the occurrence of clinically relevant infections during first -generation protease inhibitor based therapy and its risk factors as well as the relation to treatment-induced neutropenia. Methods: This multicenter (n=45) retrospective cohort study included CHC patients treated in the Netherlands. Based on absolute neutrophil count, categories of neutropenia were defined as: severe (<500/1.11,), moderate (500-750/A) and mild (750-1500/4). Likewise, infections were classified as severe (intravenous antibiotics/ hospitalization) and moderate (anti -infective treatment). We assessed risk factors for infections using multivariable regression analysis with correction for multiple measurements. Results: We included 467 CHC patients, 319 (68%) were male and 111 (24%) had cirrhosis. A total of 185 clinically relevant infections (34 severe) occurred in 145 patients (31%). During treatment 310 patients experienced neutropenia (34 severe). Multivariable analysis identified female sex (OR 1.7, 95%CI 1.2-2.5), chronic obstructive pulmonary disease (COPD) (OR 2.7, 95%CI 1.6- 4.5) and diabetes mellitus (OR 1.7, 95%CI 1.0-3.0) as risk factors for infections. Neutropenia at the previous visit was not associated with infection (univariable analysis: OR 0.9, 95%CI 0.6-1.3). Conclusion: This study shows that therapy with first generation protease inhibitors was complicated by an infection in 31% of patients. Not neutropenia, but female sex, COPD and diabetes mellitus were independent risk factors for infection. These patients should be monitored carefully once a PegIFN regimen is initiated.
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页码:197 / 204
页数:8
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