Racial differences in hepatitis C treatment eligibility

Michael 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 Sulkowski

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)70-78
Number of pages9
JournalHepatology
Volume54
Issue number1
DOIs
StatePublished - Jul 2011

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Hepatitis C
Hepacivirus
Neutropenia
Therapeutics
Ribavirin
Multicenter Studies
Renal Insufficiency
Anemia
Creatinine
Neutrophils
Chronic Disease
Clinical Trials
Confidence Intervals
Glucose

ASJC Scopus subject areas

  • Hepatology

Cite this

Melia, M., Muir, A. J., Mccone, J., Shiffman, M. L., King, J. W., Herrine, S. K., ... Sulkowski, M. (2011). Racial differences in hepatitis C treatment eligibility. Hepatology, 54(1), 70-78. https://doi.org/10.1002/hep.24358

Racial differences in hepatitis C treatment eligibility. / Melia, Michael; Muir, Andrew J.; Mccone, Jonathan; Shiffman, Mitchell L.; King, John W.; Herrine, Steven K.; Galler, Greg W.; Bloomer, Joseph R.; Nunes, Frederick A.; Brown, Kimberly A.; Mullen, Kevin D.; Ravendhran, Natarajan; Ghalib, Reem H.; Boparai, Navdeep; Jiang, Ruiyun; Noviello, Stephanie; Brass, Clifford A.; Albrecht, Janice K.; Mchutchison, John G.; Sulkowski, Mark.

In: Hepatology, Vol. 54, No. 1, 07.2011, p. 70-78.

Research output: Contribution to journalArticle

Melia, M, Muir, AJ, Mccone, J, Shiffman, ML, King, JW, Herrine, SK, Galler, GW, Bloomer, JR, Nunes, FA, Brown, KA, Mullen, KD, Ravendhran, N, Ghalib, RH, Boparai, N, Jiang, R, Noviello, S, Brass, CA, Albrecht, JK, Mchutchison, JG & Sulkowski, M 2011, 'Racial differences in hepatitis C treatment eligibility', Hepatology, vol. 54, no. 1, pp. 70-78. https://doi.org/10.1002/hep.24358
Melia M, Muir AJ, Mccone J, Shiffman ML, King JW, Herrine SK et al. Racial differences in hepatitis C treatment eligibility. Hepatology. 2011 Jul;54(1):70-78. https://doi.org/10.1002/hep.24358
Melia, Michael ; Muir, Andrew J. ; Mccone, Jonathan ; Shiffman, Mitchell L. ; King, John W. ; Herrine, Steven K. ; Galler, Greg W. ; Bloomer, Joseph R. ; Nunes, Frederick A. ; Brown, Kimberly A. ; Mullen, Kevin D. ; Ravendhran, Natarajan ; Ghalib, Reem H. ; Boparai, Navdeep ; Jiang, Ruiyun ; Noviello, Stephanie ; Brass, Clifford A. ; Albrecht, Janice K. ; Mchutchison, John G. ; Sulkowski, Mark. / Racial differences in hepatitis C treatment eligibility. In: Hepatology. 2011 ; Vol. 54, No. 1. pp. 70-78.
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