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DDW: Treatment for HCV Can Work for IV Drug Users on opiod substitution
 
 
  MedPage Today
Published: May 04, 2010
 
Action Points
 
* Explain that physicians have reservations about treatment for intravenous drug users with HCV, but this study shows that concurrent therapy with opioid substitution improves adherence and thus virologic response.
 
* Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.
 
NEW ORLEANS -- Antiviral treatment for hepatitis C (HCV) is appropriate -- and can be successful -- for IV drug users who are on opioid substitution, researchers said here.
 
About 83% of patients in a small cohort who were on methadone or buprenorphine completed a six-month treatment regimen with peginterferon and ribavirin, Olga Anagnostou, MD, of the Greek Organization Against Drugs (OKANA), and colleagues reported at a press briefing during Digestive Disease Week.
 
"Intravenous drug users should not be excluded from antiviral treatment," Anagnostou said. "They can get treated as long as they adhere, and they do adhere when they are treated in a setting such as this one."
 
Anagnostou said many physicians withhold antiviral treatment in these patients because of concerns about adherence and response rates. So she and colleagues investigated an approach in which patients would be accompanied to their hepatologist for treatment.
 
They were given peginterferon alpha-2a or 2b and ribavirin and, at the same time, an opioid substitute -- either methadone or buprenorphine.
 
Between 2002 and 2008, the researchers evaluated 95 patients on HCV treatment and opioid substitution -- 46 were on methadone and 49 were on buprenorphine.
 
The researchers found that 82.8% completed their treatment schedule; 7.5% discontinued treatment because of side effects and 9.7% had other reasons for stopping.
 
The researchers also saw sustained virologic response in 66.7% of the patients after six months. That response was higher, of course, among those who adhered to treatment (P<0.0001).
 
But it was also associated with use of buprenorphine (83.3% versus 48.9% in methadone users, P=0.002).
 
Buprenorphine was also associated with higher rates of fulfilling the treatment schedule than methadone (27.3% versus 8.1%, P=0.04).
 
Anagnostou said it may be that buprenorphine is a better treatment for the underlying opioid problem.
 
In multivariate analyses, adherence to treatment and buprenorphine use were associated with much higher odds of sustained virologic response (OR 20.5, 95% CI 3.98 to 105.45, P<0.0001 and OR 4.54, 95% CI 1.52 to 13.53, P=0.007).
 
Also in those analyses, buprenorphine use was the only variable associated with better adherence, Anagnostou said.
 
She added that researchers "need more studies to clarify the mechanism underlying this relationship."
 
Frank Anania, MD, of Emory University in Atlanta, who was not involved in the study, said the findings are important because gastroenterologists have great difficulty keeping patients with drug addiction disorders on HCV treatment.
 
"It's hard to keep them compliant with what is a very difficult regimen," he said. "Taking peginterferon and ribavirin is not unlike having chemotherapy."
 
He added that "buprenorphine appears to allow for a higher degree of adherence."
 
The researchers reported no conflicts of interest.
 
Primary source: Digestive Disease Week
Source reference:
Anagnostou O, et al "The significance of buprenorphine use
 
 
 
 
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