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Sustained Response to Interferon-based Therapy Leads to Improved Quality of Life in Chronic Hepatitis C Patients

SUMMARY: Chronic hepatitis C patients who achieve sustained virological response (SVR) to interferon-based treatment have a better of quality of life than non-responders, and these benefits last long-term after completion of therapy, according to a Canadian study reported in the October 2009 American Journal of Gastroenterology.

By Liz Highleyman

Ava John-Baptiste from the University of Toronto and colleagues compared the health status of hepatitis C patients with sustained response to interferon-based antiviral therapy -- defined as continued undetectable HCV viral load 6 months after completion of therapy -- versus that of individuals who "failed" treatment.

After finishing therapy, a total of 235 patients -- 133 sustained responders and 102 non-responders -- completed either written surveys by mail or in-person interviews. Questionnaires were completed an average of 3.7 years after the end of treatment.

The investigators used standardized health-related quality of life and preference (utility) measures:

	Hepatitis-specific Medical Outcomes Study;
	Short-Form 36-Item Health Survey (SF-36);
	Health Utilities Index Mark 2/3 (HUI-2/3);
	Time trade-off (TTO) for current health.

Respondents also provided information about demographic characteristics, history of substance abuse, co-existing conditions, and other aspects of health history. Finally, they indicated whether they missed work, volunteer activities, or household activities during the prior 3 months due to hepatitis C or its treatment. Detailed clinical information was obtained from medical chart reviews.

Results

Relatively to sustained responders, participants who did not achieve SVR after treatment had:

	Significantly lower scores on the 8 SF-36 domains (P < 0.01);
	Lower scores on hepatitis-specific domains (P < 0.0001);
	Lower physical (42.5 vs 49.2) and mental (40.5 vs 46.1) component summary scores (P < 0.01).

Non-responders also had significantly lower scores than sustained responders using other measures (all P < 0.05):

	HUI-2: 0.74 vs 0.80;
	HUI-3: 0.57 vs 0.70;
	SF-6D: 0.65 vs 0.71;
	TTO: 0.84 vs 0.89.

However, differences in HUI-2 and TTO scores were no longer significant after adjusting for demographic and clinical variables.

44% of participants who experienced treatment failure missed work, volunteer opportunities, or household activities due to hepatitis C or its treatment, compared with 9% of sustained responders (P < 0.001).

Based on these findings, the study authors concluded, "Patients with a sustained response to antiviral therapy for chronic HCV infection have better quality of life than treatment failures do."

"Our study validates the benefits associated with the sustained response to antiviral therapy in a real-world clinic population and shows that these benefits are maintained over the long term," they added.

Department of Health Policy, Management and Evaluation and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada.

12/11/09

Reference
AA John-Baptiste, G Tomlinson, PC Hsu, and others. Sustained Responders Have Better Quality of Life and Productivity Compared With Treatment Failures Long After Antiviral Therapy for Hepatitis C. American Journal of Gastroenterology. 104(10): 2439-2448 (Abstract). October 2009.