Initial uptake, time to treatment, and real-world effectiveness of all-oral direct-acting antivirals for hepatitis C virus infection in the United States: A retrospective cohort analysis

BACKGROUND: Data on initiation and utilization of direct-acting antiviral therapies for hepatitis C virus infection in the United States are limited. This study evaluated treatment initiation, time to treatment, and real-world effectiveness of direct-acting antiviral therapy in individuals with hepatitis C virus infection treated during the first 2 years of availability of all-oral direct-acting antiviral therapies. METHODS: A retrospective cohort analysis was undertaken using electronic medical records and chart review abstraction of hepatitis C virus-infected individuals aged >18 years diagnosed with chronic hepatitis C virus infection between January 1, 2014, and December 31, 2015 from the Indiana University Health database. RESULTS: Eight hundred thirty people initiated direct-acting antiviral therapy during the 2-year observation window. The estimated incidence of treatment initiation was 8.8%±0.34% at the end of year 1 and 15.0%±0.5% at the end of year 2. Median time to initiating therapy was 300 days. Using a Cox regression analysis, positive predictors of treatment initiation included age (hazard ratio, 1.008), prior hepatitis C virus treatment (1.74), cirrhosis (2.64), and history of liver transplant (1.5). History of drug abuse (0.43), high baseline alanine aminotransferase levels (0.79), hepatitis B virus infection (0.41), and self-pay (0.39) were negatively associated with treatment initiation. In the evaluable population (n = 423), 83.9% (95% confidence interval, 80.1-87.3%) of people achieved sustained virologic response. CONCLUSION: In the early years of the direct-acting antiviral era, <10% of people diagnosed with chronic hepatitis C virus infection received direct-acting antiviral treatment; median time to treatment initiation was 300 days. Future analyses should evaluate time to treatment initiation among those with less advanced fibrosis

MIASTENIA GRAVIS: EMBARAZO E IMPACTO PERINATAL

Se analizan 19 embarazos en 9 pacientes con miastenia gravis. Hubo 2 exacerbaciones de la enfermedad, una de esta asociada al uso de aminoglicósidos en el tratamiento de pielonefritis aguda. En un caso la enfermedad debutó a las 24 semanas de gestación. Hubo tres casos de miastenia gravis neonatal en la misma gestante, 2 de los recién nacidos fallecieron a los 29 y 25 días respectivamente, pese al tratamiento. Hubo un recién nacido de pretérmino y 6 casos (35%) de restricción del crecimiento intrauterin

MIASTENIA GRAVIS: EMBARAZO E IMPACTO PERINATAL

Se analizan 19 embarazos en 9 pacientes con miastenia gravis. Hubo 2 exacerbaciones de la enfermedad, una de esta asociada al uso de aminoglicósidos en el tratamiento de pielonefritis aguda. En un caso la enfermedad debutó a las 24 semanas de gestación. Hubo tres casos de miastenia gravis neonatal en la misma gestante, 2 de los recién nacidos fallecieron a los 29 y 25 días respectivamente, pese al tratamiento. Hubo un recién nacido de pretérmino y 6 casos (35%) de restricción del crecimiento intrauterino<br>A total of 19 pregnancies in 9 patients with myasthenia gravis are analyzed. Two exacerbations of myasthenia gravis were observed. One associated to the use of aminoglycosides to treat an acute pyelonephritis. A debut of myasthenia gravis occurred during the 24th week of gestation. There were three cases of neonatal myasthenia gravis that appeared in the same patient, two newborn died after 29 and 25 days respectively, in spite of treatment. One case of preterm childbirth was observed and six cases (35%) of intrauterine growth retardatio