Patient-reported outcomes in individuals with hepatitis C virus infection treated with elbasvir/grazoprevir

Xinyi Ng, Chizoba Nwankwo, Jean Marie Arduino, Shelby Corman, Kathryn Eilene Lasch, Jacqueline Mary Lustrino, Sushma Patel, Heather Loryn Platt, Jingjun Qiu, Jan Sperl, Xinyi Ng, Chizoba Nwankwo, Jean Marie Arduino, Shelby Corman, Kathryn Eilene Lasch, Jacqueline Mary Lustrino, Sushma Patel, Heather Loryn Platt, Jingjun Qiu, Jan Sperl

Abstract

Purpose: People chronically infected with hepatitis C virus (HCV) have diminished patient-reported outcomes (PROs). This study aimed to compare the impact of elbasvir/grazoprevir (EBR/GZR) treatment versus sofosbuvir with pegylated interferon and ribavirin (SOF/PR) on changes in PROs: 1) during the treatment period and 2) at posttreatment follow-up.

Patients and methods: PRO data collected during the Phase III C-EDGE Head-2-Head (H2H) open-label study was analyzed. In this trial, patients infected with HCV were randomized 1:1 to receive either EBR/GZR or SOF/PR for 12 weeks. Patients self-administered the Short Form-36 version 2 (SF-36v2®) Health Survey Acute (1-week recall) Form and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Scale at baseline, during treatment, and posttreatment. Between-group differences in mean change of PRO scores from baseline were estimated during the treatment period and also at the posttreatment follow-up. Effect sizes were calculated to evaluate if the detected change in mean PRO scores is clinically meaningful between groups.

Results: There were 255 patients (99.2% White, 54.1% female, 74.9% treatment naïve) included in the analysis. During the treatment period, significant declines in SF-36v2 scores were observed across all domains for the SOF/PR group. Compared to the SOF/PR group, the EBR/GZR group reported more improvement in scores across all SF-36v2 domain scores at the end of the treatment period. At treatment week 12, the between-group differences for 6 out of the 8 domain scores for these patients reflected at least moderate effects (effect sizes >0.5). No significant between-group differences in change in SF-36v2 scores from baseline were detected posttreatment. The decline in SF-36v2 scores observed during the treatment period for the SOF/PR group returned to near baseline scores or above posttreatment. Treatment with EBR/GZR did not impact fatigue scores, but treatment with SOF/PR led to increased fatigue scores during treatment which resolved by posttreatment follow-up week 12.

Conclusion: This study demonstrated that HCV treatment with EBR/GZR resulted in a significantly better PRO profile as compared to SOF/PR. PROs are an important consideration as worsening PROs experienced during treatment may negatively influence adherence and ultimately contribute to an unfavorable clinical outcome.

Clinicaltrialsgov identifier: NCT02358044.

Keywords: direct-acting antivirals; fatigue; health-related quality of life; hepatitis; patient-reported outcomes.

Conflict of interest statement

Disclosure XN, SC, JML, and KEL are employees of Pharmerit International, LP. XN, SC, JML, and KEL are paid consultants to Merck for the purpose of this submitted work. CN, JMA, SP, and HLP are employees/shareholders of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. JQ was involved in this manuscript while she was an employee of Merck & Co., Inc., Kenilworth, NJ, USA. JS received research grants and personal fees from AbbVie, Merck, Gilead, Bristol-Myers Squibb, and Herbacos Recordati, outside of this submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Mean change in SF-36v2 scores from baseline. Note: Error bars indicate 95% CIs. Abbreviations: BP, bodily pain; EBR/GZR, elbasvir/grazoprevir; GH, general health; MCS, mental component summary; MH, mental health; PCS, physical component summary; PF, physical functioning; RE, role limitations-emotional; RP, role limitations-physical; SF, social functioning; SOF/PR, sofosbuvir with pegylated interferon and ribavirin; VT, vitality.
Figure 2
Figure 2
Summary of between-group differences and effect sizes for change in SF-36v2 scores from baseline. Notes: Error bars indicate 95% CIs. Abbreviations: BP, bodily pain; EBR/GZR, elbasvir/grazoprevir; GH, general health; MCS, mental component summary; MH, mental health; PCS, physical component summary; PF, physical functioning; RE, role limitations-emotional; RP, role limitations-physical; SF, social functioning; VT, vitality.
Figure 3
Figure 3
Mean change in FACIT-Fatigue Scale scores from baseline. Note: Error bars indicate 95% CI. Abbreviations: EBR/GZR, elbasvir/grazoprevir; FACIT-Fatigue, Functional Assessment of Chronic Illness Therapy-Fatigue; SOF/PR, sofosbuvir with pegylated interferon and ribavirin.
Figure 4
Figure 4
Summary of between-group differences and effect sizes for change in FACIT-Fatigue scale scores from baseline. Notes: Error bars indicate 95% CIs. Abbreviations: BP, bodily pain; EBR/GZR, elbasvir/grazoprevir; FACIT-Fatigue Scale, Functional Assessment of Chronic Illness Therapy-Fatigue Scale.

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