Racial differences in hepatitis C treatment eligibility
Michael T Melia, Andrew J Muir, Jonathan McCone, Mitchell L Shiffman, John W King, Steven K Herrine, Greg W Galler, Joseph R Bloomer, Frederick A Nunes, Kimberly A Brown, Kevin D Mullen, Natarajan Ravendhran, Reem H Ghalib, Navdeep Boparai, Ruiyun Jiang, Stephanie Noviello, Clifford A Brass, Janice K Albrecht, John G McHutchison, Mark S Sulkowski, IDEAL Study Team, Nezam Afdhal, Abdullah Al-Osaimi, B Bacon, Luis Balart, Michael Bennett, David Bernstein, Edmund Bini, Martin Black, Hector Bonilla, Terry Box, Thomas Boyer, Norbert Brau, Robert Brown, Christine Bruno, Raymond Chung, David Clain, Jeffrey Crippin, Douglas Dalke, Charles Davis, Gary Davis, Mitchell Davis, Franco Felizarta, Roberto Firpi-Morell, Steven Flamm, Jose Franco, Bradley Freilich, Joseph Galati, Alexandra Gibas, Eliot Godofsky, Fredric Gordon, John Gross, Stephen Harrison, Jorge Herrera, Robert Herring, Ke-Qin Hu, Jonathan Israel, Ira Jacobson, Shobha Joshi, Mandana Khalili, Alan Kilby, Paul King, Alvaro Koch, Edward Krawitt, Marcelo Kugelmas, Paul Kwo, Louis Lambiase, Eric Lawitz, Edward Lebovics, William Lee, James Levin, Robert Levine, Steven Lidofsky, Michael Lucey, Mark Mailliard, Luis Marsano, Paul Martin, Thomas McGarrity, Dennis Mikolich, Timothy Morgan, Santiago Munoz, Donald Nelson, Anders Nyberg, Lisa Nyberg, Sangik Oh, Prashant Pandya, Mary Pat Pauly, Craig Peine, Robert Perrillo, Gary Poleynard, Fred Poordad, Anthony Post, John Poulos, David Pound, Mordechai Rabinovitz, Joanna Ready, Rajender Reddy, Robert Reindollar, Adrian Reuben, Lorenzo Rossaro, Lawrence Rothman, Raymond Rubin, Vinod Rustgi, Michael Ryan, E Schiff, Warren Schmidt, William Semon, Thomas Sepe, Kenneth Sherman, Maria Sjogren, Robert Sjogren, Coleman Smith, Lawrence Stein, Robert Strauss, Mark Swaim, Gyongnyi Szabo, Joseph Thurn, Myron Tong, John Vierling, George Wu, Rockford Yapp, Ziad Younes, Atif Zaman, Michael T Melia, Andrew J Muir, Jonathan McCone, Mitchell L Shiffman, John W King, Steven K Herrine, Greg W Galler, Joseph R Bloomer, Frederick A Nunes, Kimberly A Brown, Kevin D Mullen, Natarajan Ravendhran, Reem H Ghalib, Navdeep Boparai, Ruiyun Jiang, Stephanie Noviello, Clifford A Brass, Janice K Albrecht, John G McHutchison, Mark S Sulkowski, IDEAL Study Team, Nezam Afdhal, Abdullah Al-Osaimi, B Bacon, Luis Balart, Michael Bennett, David Bernstein, Edmund Bini, Martin Black, Hector Bonilla, Terry Box, Thomas Boyer, Norbert Brau, Robert Brown, Christine Bruno, Raymond Chung, David Clain, Jeffrey Crippin, Douglas Dalke, Charles Davis, Gary Davis, Mitchell Davis, Franco Felizarta, Roberto Firpi-Morell, Steven Flamm, Jose Franco, Bradley Freilich, Joseph Galati, Alexandra Gibas, Eliot Godofsky, Fredric Gordon, John Gross, Stephen Harrison, Jorge Herrera, Robert Herring, Ke-Qin Hu, Jonathan Israel, Ira Jacobson, Shobha Joshi, Mandana Khalili, Alan Kilby, Paul King, Alvaro Koch, Edward Krawitt, Marcelo Kugelmas, Paul Kwo, Louis Lambiase, Eric Lawitz, Edward Lebovics, William Lee, James Levin, Robert Levine, Steven Lidofsky, Michael Lucey, Mark Mailliard, Luis Marsano, Paul Martin, Thomas McGarrity, Dennis Mikolich, Timothy Morgan, Santiago Munoz, Donald Nelson, Anders Nyberg, Lisa Nyberg, Sangik Oh, Prashant Pandya, Mary Pat Pauly, Craig Peine, Robert Perrillo, Gary Poleynard, Fred Poordad, Anthony Post, John Poulos, David Pound, Mordechai Rabinovitz, Joanna Ready, Rajender Reddy, Robert Reindollar, Adrian Reuben, Lorenzo Rossaro, Lawrence Rothman, Raymond Rubin, Vinod Rustgi, Michael Ryan, E Schiff, Warren Schmidt, William Semon, Thomas Sepe, Kenneth Sherman, Maria Sjogren, Robert Sjogren, Coleman Smith, Lawrence Stein, Robert Strauss, Mark Swaim, Gyongnyi Szabo, Joseph Thurn, Myron Tong, John Vierling, George Wu, Rockford Yapp, Ziad Younes, Atif Zaman
Abstract
Black Americans are disproportionally infected with hepatitis C virus (HCV) and are less likely than whites to respond to treatment with peginterferon (PEG-IFN) plus ribavirin (RBV). The impact of race on HCV treatment eligibility is unknown. We therefore performed a retrospective analysis of a phase 3B multicenter clinical trial conducted at 118 United States community and academic medical centers to evaluate the rates of and reasons for HCV treatment ineligibility according to self-reported race. In all, 4,469 patients were screened, of whom 1,038 (23.2%) were treatment ineligible. Although blacks represented 19% of treated patients, they were more likely not to be treated due to ineligibility and/or failure to complete required evaluations (40.2%) than were nonblack patients (28.5%; P < 0.001). After the exclusion of persons not treated due to undetectable HCV RNA or nongenotype 1 infection, blacks were 65% less likely than nonblacks to be eligible for treatment (28.1% > 17.0%; relative risk, 1.65; 95% confidence interval, 1.46-1.87; P < 0.001). Blacks were more likely to be ineligible due to neutropenia (14% versus 3%, P < 0.001), anemia (7% versus 4%, P = 0.02), elevated glucose (8% versus 3%, P < 0.001), and elevated creatinine (5% versus 1%, P < 0.001).
Conclusion: Largely due to a higher prevalence of neutropenia and uncontrolled medical conditions, blacks were significantly less likely to be eligible for HCV treatment. Increased access to treatment may be facilitated by less conservative neutrophil requirements and more effective care for chronic diseases, namely, diabetes and renal insufficiency.
Trial registration: ClinicalTrials.gov NCT00081770.
Copyright © 2011 American Association for the Study of Liver Diseases.
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Source: PubMed