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Omar H, El Akel W, Elbaz T, El Kassas M, Elsaeed K, El Shazly H, Said M, Yousif M, Gomaa AA, Nasr A, AbdAllah M, Korany M, Ismail SA, Shaker MK, Doss W, Esmat G, Waked I, El Shazly Y. Generic daclatasvir plus sofosbuvir, with or without ribavirin, in treatment of chronic hepatitis C: real-world results from 18 378 patients in Egypt. Aliment Pharmacol Ther 2018; 47:421-431. [PMID: 29193226 DOI: 10.1111/apt.14428] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/22/2017] [Accepted: 10/30/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Treatment of chronic hepatitis C using combination of sofosbuvir (SOF) and daclatasvir (DCV) was used in several clinical trials and multicentre studies, which were somewhat limited to genotypes 1-3. The national program in Egypt is using SOF-DCV combination for large scale treatment. AIM To assess the efficacy and safety of combined SOF-DCV in treating patients with HCV-G4 in a real-world setting. METHODS Data and outcome of chronic HCV patients who were treated for 12 weeks with generic medications: DCV 60 mg plus SOF 400 mg ± ribavirin (RBV) within the national hepatitis C treatment program in Egypt are presented. Treatment-naïve patients without cirrhosis were treated without RBV, and those who had cirrhosis or were treatment-experienced (interferon experienced or SOF experienced) received RBV. Efficacy and safety were assessed, and baseline factors associated with sustained virological response at post-treatment week 12 (SVR12) were explored. RESULTS During the first 2 months of the programme, 18 378 patients with HCV-G4 started treatment with SOF-DCV with or without RBV. Overall, 95.1% achieved SVR12 (95.4% among patients treated without RBV and 94.7% for patients treated with RBV, P = .32). Treatment was prematurely discontinued in only 1.5% of patients. The most common events leading to discontinuation were patient withdrawal (n = 76) and pregnancy (n = 5). Five deaths occurred within this group. CONCLUSIONS Real-world experience of generic SOF-DCV in patients with chronic HCV-G4 proved to be safe and associated with a high SVR12 rate, in patients with different stages of fibrosis.
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Affiliation(s)
- H Omar
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - W El Akel
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - T Elbaz
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M El Kassas
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - K Elsaeed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H El Shazly
- National Liver Institute, Menoufiya University, Shebeen EL Kom, Egypt
| | - M Said
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M Yousif
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A A Gomaa
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - A Nasr
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - M Korany
- National Committee for Control of Viral Hepatitis, Cairo, Egypt
| | - S A Ismail
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - M K Shaker
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - W Doss
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - G Esmat
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - I Waked
- National Liver Institute, Menoufiya University, Shebeen EL Kom, Egypt
| | - Y El Shazly
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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El-Akel W, El-Sayed MH, El Kassas M, El-Serafy M, Khairy M, Elsaeed K, Kabil K, Hassany M, Shawky A, Yosry A, Shaker MK, ElShazly Y, Waked I, Esmat G, Doss W. National treatment programme of hepatitis C in Egypt: Hepatitis C virus model of care. J Viral Hepat 2017; 24:262-267. [PMID: 28145032 DOI: 10.1111/jvh.12668] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023]
Abstract
Hepatitis C virus (HCV) infection is a major health problem in Egypt as the nation bears the highest prevalence rate worldwide. This necessitated establishing a novel model of care (MOC) to contain the epidemic, deliver patient care and ensure global treatment access. In this review, we describe the process of development of the Egyptian model and future strategies for sustainability. Although the magnitude of the HCV problem was known for many years, the HCV MOC only came into being in 2006 with the establishment of the National Committee for Control of Viral Hepatitis (NCCVH) to set up and implement a national control strategy for the disease and other causes of viral hepatitis. The strategy outlines best practices for patient care delivery by applying a set of service principles through identified clinical streams and patient flow continuums. The Egyptian national viral hepatitis treatment programme is considered one of the most successful and effective public health programmes. To date, more than one million patients were evaluated and more than 850 000 received treatment under the umbrella of the programme since 2006. The NCCVH has been successful in establishing a strong infrastructure for controlling viral hepatitis in Egypt. It established a nationwide network of digitally connected viral hepatitis-specialized treatment centres covering the country map to enhance treatment access. Practice guidelines suiting local circumstances were issued and regularly updated and are applied in all affiliated centres. This review illustrates the model and the successful Egyptian experience. It sets an exemplar for states, organizations and policy-makers setting up programmes for care and management of people with hepatitis C.
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Affiliation(s)
- W El-Akel
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M H El-Sayed
- Pediatrics (Hematology/Oncology), Ain Shams University, Cairo, Egypt
| | - M El Kassas
- Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - M El-Serafy
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M Khairy
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - K Elsaeed
- Internal Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - K Kabil
- New Pediatric Children Hospital, Cairo University, Cairo, Egypt
| | - M Hassany
- Department of Tropical Diseases, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - A Shawky
- Internal Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - A Yosry
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M K Shaker
- Tropical Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Y ElShazly
- Internal Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - I Waked
- Department of Hepatology, National Liver Institute, Shebin El-Kom, Egypt
| | - G Esmat
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - W Doss
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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El Sharkawy M, Elsaeed K, Kamel M, Aziz A, Del Pozo C, Balk A, Castello-Banyuls J, Navarro D, Pere B, Faura CC, Ballesta JJ, Rodig N, Vilalta R, Hernandez J, Camacho Diaz J, Lapeyraque AL, Sherwinter J, Gruppo R, Fremont O, Baudouin V, Langman C, Simonetti GD, Loirat C, Muus P, Legendre C, Douglas K, Hourmant M, Delmas Y, Herthelius M, Trivelli A, Goodship T, Bedrosian C, Licht C, Schlesinger N, Lin HY, De Meulemeester M, Rovensky J, Krammer G, Balfour A, So A, Carrero JJ, Sonmez A, Saglam M, Stenvinkel P, Yaman H, Quresi AR, Yenicesu M, Yilmaz MI, McQuarrie E, Freel M, Mark P, Patel R, Steedman T, Fraser R, Dargie H, Connell J, Jardine A, McQuarrie E, Freel M, Mark P, Fraser R, Connell J, Jardine A, Oh SW, Chin HJ, Na KY, Chae DW, Alfieri C, Vettoretti S, Cafforio C, Floreani R, Bonanomi C, Danzi G, Messa P, Whelton A, MacDonald P, Hunt B, Gunawardhana L, Rusu E, Voiculescu M, Zilisteanu D, Ecobici M, Arsenescu I, Ismail G, Macarie C, Chan D, Irish A, Watts G, Dogra G, Krueger T, Schlieper G, Cozzolino M, Eckardt KU, Jadoul M, Ketteler M, Leunissen K, Rump LC, Stenvinkel P, Wiecek A, Westenfeld R, Hilgers RD, Mahnken AH, Schurgers LJ, Floege J, Onuigbo M, Onuigbo N, Onuigbo M, Trevisani F, Sciarrone Alibrandi MT, Bertini R, Montorsi F, Delli Carpini S, Camerota TC, Antoniolli S, Citterio L, Querques M, Merlino L, Manunta P, Ebah L, Morgan J, Brenchley P, Mitra S, Krumme B, Boehler J, Mettang T, Strutz F, Georginova O, Rykova S, Gafarova M, Smyr K, Sokolova I, Krasnova T, Kozlovskaya L. Pathophysiology and clinical studies in CKD 1-5. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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