Study: PCPs Could Treat Hepatitis C as Efficiently as Specialists

In a study presented at The International Liver Congress 2016 in Barcelona, Spain, researchers found that treatment for hepatitis C can be safely and effectively delivered in a community-based, nonspecialist, primary care environment.

In a multicenter, open-label, phase 4 clinical trial, investigators evaluated 304 chronic hepatitis C virus (HCV)-infected patients at various United States-based community health centers, administering nonrandomized treatment from a specialist provider, primary care physician, or nurse practitioner. These providers all took part in the same training on the Infectious Disease Society of America/American Association for the Study of Liver Disease guidelines for HCV, the authors note, adding that patients received the same treatments with direct-acting antivirals, and outcomes were assessed via a composite attendance score and an unquantifiable HCV RNA viral load 12 weeks after finishing treatment (SVR12).
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Of the 304 patients studied, 285 achieved SVR12, with no substantial variance found between providers. Overall, 92.1% of patients received care from specialists achieved SVR12, while 96.7% and 94.9% achieved the same outcome after receiving care from primary care physicians and nurse practitioners, respectively.

“These findings signify that primary care providers can efficiently learn HCV management using direct-acting antivirals, and effectively treat their patients with cure rates comparable to [those] observed in patients treated by their specialist colleagues,” said Sarah Kattakuzhy, MD, an assistant professor at the University of Maryland School of Medicine, and lead author of the study.

While noting that these results are not applicable to all medications or clinical scenarios, Kattakuzhy suggested that the study “supports the notion that primary care providers can and should play an active role in combating the hepatitis C epidemic.”

Management of uncomplicated hepatitis C infection, she said, “could be a part of primary care and may not require specialist referral.”

—Mark McGraw

Reference:

Wilson EMP, Kattakuzhy S, Sims Z, et al. High efficacy of retreatment with ledpasvir and sofosbuvir in hcv patients who failed initial short course therapy with combination DAA regimens (NIH synergy trial) [presented at the International Liver Congress, 2016].