title: Predictors of Early Discontinuation of Pegylated Interferon for Reasons Other Than Lack of Efficacy in United States Veterans With Chronic Hepatitis C.
abstract: During the dual-therapy era, many patients with chronic hepatitis C discontinued therapy for reasons other than lack of efficacy (non-LOE). We determined whether selected patient characteristics predicted non-LOE discontinuation using national databases of U.S. veterans with Genotypes 1-4. We identified U.S. veterans in the Veterans Health Administration system in 2004-2009 who had hepatitis C-confirming RNA laboratory results and initiated therapy with pegylated interferon and ribavirin. We used a rule to classify patients who discontinued pegylated interferon early, based on pharmacy refill and viral response data. Multivariate Cox regression was used to identify predictors of non-LOE discontinuation. Of 321,238 patients with a hepatitis C International Classification of Diseases, Ninth Revision, code, 15,297 (4.8%) met all inclusion criteria. Non-LOE discontinuers comprised 30.3% of patients. For Genotypes 1-4, the predictors (adjusted hazard ratio) of greatest magnitude were comorbidities of myocardial infarction/congestive heart failure (1.36), renal disease (1.34), and platelets 100/mm or more (1.38). For Genotypes 2 and 3, predictors of greatest magnitude were Black race (1.30), myocardial infarction/congestive heart failure (1.84), albumin 3.5 mg/dl or more (1.65), sleep aid use (1.32), and poor persistence with antidepressants (1.31) and antihypertensive agents (1.37). Our study suggests that many host factors may have contributed to non-LOE dual-therapy discontinuation in veterans and may possibly predict non-LOE discontinuation in triple therapy.
authors.affiliation: Joanne LaFleur, PharmD, MSPH, is Associate Professor, Pharmacotherapy Outcomes Research Center, Salt Lake City, Utah. Robert Hoop, MPH, is Principal Health Economist, Genentech, South San Francisco, California. Eli Korner, PharmD, is Senior Medical Science Director, Infectious Diseases, Genentech, South San Francisco, California. Scott DuVall, PhD, is Research Assistant Professor, VA Salt Lake City Health Care System IDEAS Center, Salt Lake City, Utah. Timothy Morgan, MD, is Chief of Hepatology, VA Long Beach Healthcare System, Long Beach, California. Prashant Pandya, MD, is Associate Professor of Medicine, Kansas City VA Medical Center, Kansas City, Missouri. Jian Han, PhD, is Statistician, Genentech, South San Francisco, California. Kristin Knippenberg, MFA, is Medical Writer, Pharmacotherapy Outcomes Research Center, Salt Lake City, Utah. Richard E. Nelson, PhD, is Research Assistant Professor, VA Salt Lake City Health Care System IDEAS Center, GRECC 151, Salt Lake City, Utah.
authors.forename: Joanne
authors.initials: J
authors.lastname: LaFleur
authors.forename: Robert
authors.initials: R
authors.lastname: Hoop
authors.forename: Eli
authors.initials: E
authors.lastname: Korner
authors.forename: Scott
authors.initials: S
authors.lastname: DuVall
authors.forename: Timothy
authors.initials: T
authors.lastname: Morgan
authors.forename: Prashant
authors.initials: P
authors.lastname: Pandya
authors.forename: Jian
authors.initials: J
authors.lastname: Han
authors.forename: Kristin
authors.initials: K
authors.lastname: Knippenberg
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
mesh_terms: D005260:Female; D005544:Forecasting; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012254:Ribavirin / Q000008:administration & dosage; D014481:United States; D014728:Veterans
chemical_list: D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a