A comprehensive assessment of patient reported symptom burden, medical comorbidities, and functional well being in patients initiating direct acting antiviral therapy for chronic hepatitis C: Results from a large US multi-center observational study

Donna M. Evon, Paul W. Stewart, Jipcy Amador, Marina Serper, Anna S. Lok, Richard K. Sterling, Souvik Sarkar, Carol E. Golin, Bryce B. Reeve, David R. Nelson, Nancy Reau, Joseph K. Lim, K. Rajender Reddy, Adrian M. Di Bisceglie, Michael W. Fried

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Symptom burden, medical comorbidities, and functional well-being of patients with chronic hepatitis C virus (HCV) initiating direct acting antiviral (DAA) therapy in real-world clinical settings are not known. We characterized these patient-reported outcomes (PROs) among HCV-infected patients and explored associations with sociodemographic, liver disease, and psychiatric/substance abuse variables. Methods and findings PROP UP is a large US multicenter observational study that enrolled 1,600 patients with chronic HCV in 2016–2017. Data collected prior to initiating DAA therapy assessed the following PROs: number of medical comorbidities; neuropsychiatric, somatic, gastrointestinal symptoms (PROMIS surveys); overall symptom burden (Memorial Symptom Assessment Scale); and functional well-being (HCV-PRO). Candidate predictors included liver disease markers and patient-reported sociodemographic, psychiatric, and alcohol/drug use features. Predictive models were explored using a random selection of 700 participants; models were then validated with data from the remaining 900 participants. The cohort was 55% male, 39% non-white, 48% had cirrhosis (12% with advanced cirrhosis); 52% were disabled or unemployed; 63% were on public health insurance or uninsured; and over 40% had markers of psychiatric illness. The median number of medical comorbidities was 4 (range: 0–15), with sleep disorders, chronic pain, diabetes, joint pain and muscle aches being present in 20–50%. Fatigue, sleep disturbance, pain and neuropsychiatric symptoms were present in over 60% and gastrointestinal symptoms in 40–50%. In multivariable validation models, the strongest and most frequent predictors of worse PROs were disability, unemployment, and use of psychiatric medications, while liver markers generally were not. Conclusions This large multi-center cohort study provides a comprehensive and contemporary assessment of the symptom burden and comorbid medical conditions in patients with HCV treated in real world settings. Pain, fatigue, and sleep disturbance were common and often severe. Sociodemographic and psychiatric markers were the most robust predictors of PROs. Future research that includes a rapidly changing population of HCV-infected individuals needs to evaluate how DAA therapy affects PROs and elucidate which symptoms resolve with viral eradication.

Original languageEnglish (US)
Article numbere0196908
JournalPLoS One
Volume13
Issue number8
DOIs
StatePublished - Aug 1 2018

Fingerprint

chronic hepatitis C
observational studies
Chronic Hepatitis C
Viruses
Hepacivirus
signs and symptoms (animals and humans)
Observational Studies
Antiviral Agents
Comorbidity
Psychiatry
Hepatitis C virus
therapeutics
Liver
Symptom Assessment
Pain
pain
Fatigue
Liver Diseases
Sleep
Fibrosis

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

A comprehensive assessment of patient reported symptom burden, medical comorbidities, and functional well being in patients initiating direct acting antiviral therapy for chronic hepatitis C : Results from a large US multi-center observational study. / Evon, Donna M.; Stewart, Paul W.; Amador, Jipcy; Serper, Marina; Lok, Anna S.; Sterling, Richard K.; Sarkar, Souvik; Golin, Carol E.; Reeve, Bryce B.; Nelson, David R.; Reau, Nancy; Lim, Joseph K.; Reddy, K. Rajender; Di Bisceglie, Adrian M.; Fried, Michael W.

In: PLoS One, Vol. 13, No. 8, e0196908, 01.08.2018.

Research output: Contribution to journalArticle

Evon, Donna M. ; Stewart, Paul W. ; Amador, Jipcy ; Serper, Marina ; Lok, Anna S. ; Sterling, Richard K. ; Sarkar, Souvik ; Golin, Carol E. ; Reeve, Bryce B. ; Nelson, David R. ; Reau, Nancy ; Lim, Joseph K. ; Reddy, K. Rajender ; Di Bisceglie, Adrian M. ; Fried, Michael W. / A comprehensive assessment of patient reported symptom burden, medical comorbidities, and functional well being in patients initiating direct acting antiviral therapy for chronic hepatitis C : Results from a large US multi-center observational study. In: PLoS One. 2018 ; Vol. 13, No. 8.
@article{6220a1bd50fd4f908b4f58716094c86d,
title = "A comprehensive assessment of patient reported symptom burden, medical comorbidities, and functional well being in patients initiating direct acting antiviral therapy for chronic hepatitis C: Results from a large US multi-center observational study",
abstract = "Background Symptom burden, medical comorbidities, and functional well-being of patients with chronic hepatitis C virus (HCV) initiating direct acting antiviral (DAA) therapy in real-world clinical settings are not known. We characterized these patient-reported outcomes (PROs) among HCV-infected patients and explored associations with sociodemographic, liver disease, and psychiatric/substance abuse variables. Methods and findings PROP UP is a large US multicenter observational study that enrolled 1,600 patients with chronic HCV in 2016–2017. Data collected prior to initiating DAA therapy assessed the following PROs: number of medical comorbidities; neuropsychiatric, somatic, gastrointestinal symptoms (PROMIS surveys); overall symptom burden (Memorial Symptom Assessment Scale); and functional well-being (HCV-PRO). Candidate predictors included liver disease markers and patient-reported sociodemographic, psychiatric, and alcohol/drug use features. Predictive models were explored using a random selection of 700 participants; models were then validated with data from the remaining 900 participants. The cohort was 55{\%} male, 39{\%} non-white, 48{\%} had cirrhosis (12{\%} with advanced cirrhosis); 52{\%} were disabled or unemployed; 63{\%} were on public health insurance or uninsured; and over 40{\%} had markers of psychiatric illness. The median number of medical comorbidities was 4 (range: 0–15), with sleep disorders, chronic pain, diabetes, joint pain and muscle aches being present in 20–50{\%}. Fatigue, sleep disturbance, pain and neuropsychiatric symptoms were present in over 60{\%} and gastrointestinal symptoms in 40–50{\%}. In multivariable validation models, the strongest and most frequent predictors of worse PROs were disability, unemployment, and use of psychiatric medications, while liver markers generally were not. Conclusions This large multi-center cohort study provides a comprehensive and contemporary assessment of the symptom burden and comorbid medical conditions in patients with HCV treated in real world settings. Pain, fatigue, and sleep disturbance were common and often severe. Sociodemographic and psychiatric markers were the most robust predictors of PROs. Future research that includes a rapidly changing population of HCV-infected individuals needs to evaluate how DAA therapy affects PROs and elucidate which symptoms resolve with viral eradication.",
author = "Evon, {Donna M.} and Stewart, {Paul W.} and Jipcy Amador and Marina Serper and Lok, {Anna S.} and Sterling, {Richard K.} and Souvik Sarkar and Golin, {Carol E.} and Reeve, {Bryce B.} and Nelson, {David R.} and Nancy Reau and Lim, {Joseph K.} and Reddy, {K. Rajender} and {Di Bisceglie}, {Adrian M.} and Fried, {Michael W.}",
year = "2018",
month = "8",
day = "1",
doi = "10.1371/journal.pone.0196908",
language = "English (US)",
volume = "13",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "8",

}

TY - JOUR

T1 - A comprehensive assessment of patient reported symptom burden, medical comorbidities, and functional well being in patients initiating direct acting antiviral therapy for chronic hepatitis C

T2 - Results from a large US multi-center observational study

AU - Evon, Donna M.

AU - Stewart, Paul W.

AU - Amador, Jipcy

AU - Serper, Marina

AU - Lok, Anna S.

AU - Sterling, Richard K.

AU - Sarkar, Souvik

AU - Golin, Carol E.

AU - Reeve, Bryce B.

AU - Nelson, David R.

AU - Reau, Nancy

AU - Lim, Joseph K.

AU - Reddy, K. Rajender

AU - Di Bisceglie, Adrian M.

AU - Fried, Michael W.

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background Symptom burden, medical comorbidities, and functional well-being of patients with chronic hepatitis C virus (HCV) initiating direct acting antiviral (DAA) therapy in real-world clinical settings are not known. We characterized these patient-reported outcomes (PROs) among HCV-infected patients and explored associations with sociodemographic, liver disease, and psychiatric/substance abuse variables. Methods and findings PROP UP is a large US multicenter observational study that enrolled 1,600 patients with chronic HCV in 2016–2017. Data collected prior to initiating DAA therapy assessed the following PROs: number of medical comorbidities; neuropsychiatric, somatic, gastrointestinal symptoms (PROMIS surveys); overall symptom burden (Memorial Symptom Assessment Scale); and functional well-being (HCV-PRO). Candidate predictors included liver disease markers and patient-reported sociodemographic, psychiatric, and alcohol/drug use features. Predictive models were explored using a random selection of 700 participants; models were then validated with data from the remaining 900 participants. The cohort was 55% male, 39% non-white, 48% had cirrhosis (12% with advanced cirrhosis); 52% were disabled or unemployed; 63% were on public health insurance or uninsured; and over 40% had markers of psychiatric illness. The median number of medical comorbidities was 4 (range: 0–15), with sleep disorders, chronic pain, diabetes, joint pain and muscle aches being present in 20–50%. Fatigue, sleep disturbance, pain and neuropsychiatric symptoms were present in over 60% and gastrointestinal symptoms in 40–50%. In multivariable validation models, the strongest and most frequent predictors of worse PROs were disability, unemployment, and use of psychiatric medications, while liver markers generally were not. Conclusions This large multi-center cohort study provides a comprehensive and contemporary assessment of the symptom burden and comorbid medical conditions in patients with HCV treated in real world settings. Pain, fatigue, and sleep disturbance were common and often severe. Sociodemographic and psychiatric markers were the most robust predictors of PROs. Future research that includes a rapidly changing population of HCV-infected individuals needs to evaluate how DAA therapy affects PROs and elucidate which symptoms resolve with viral eradication.

AB - Background Symptom burden, medical comorbidities, and functional well-being of patients with chronic hepatitis C virus (HCV) initiating direct acting antiviral (DAA) therapy in real-world clinical settings are not known. We characterized these patient-reported outcomes (PROs) among HCV-infected patients and explored associations with sociodemographic, liver disease, and psychiatric/substance abuse variables. Methods and findings PROP UP is a large US multicenter observational study that enrolled 1,600 patients with chronic HCV in 2016–2017. Data collected prior to initiating DAA therapy assessed the following PROs: number of medical comorbidities; neuropsychiatric, somatic, gastrointestinal symptoms (PROMIS surveys); overall symptom burden (Memorial Symptom Assessment Scale); and functional well-being (HCV-PRO). Candidate predictors included liver disease markers and patient-reported sociodemographic, psychiatric, and alcohol/drug use features. Predictive models were explored using a random selection of 700 participants; models were then validated with data from the remaining 900 participants. The cohort was 55% male, 39% non-white, 48% had cirrhosis (12% with advanced cirrhosis); 52% were disabled or unemployed; 63% were on public health insurance or uninsured; and over 40% had markers of psychiatric illness. The median number of medical comorbidities was 4 (range: 0–15), with sleep disorders, chronic pain, diabetes, joint pain and muscle aches being present in 20–50%. Fatigue, sleep disturbance, pain and neuropsychiatric symptoms were present in over 60% and gastrointestinal symptoms in 40–50%. In multivariable validation models, the strongest and most frequent predictors of worse PROs were disability, unemployment, and use of psychiatric medications, while liver markers generally were not. Conclusions This large multi-center cohort study provides a comprehensive and contemporary assessment of the symptom burden and comorbid medical conditions in patients with HCV treated in real world settings. Pain, fatigue, and sleep disturbance were common and often severe. Sociodemographic and psychiatric markers were the most robust predictors of PROs. Future research that includes a rapidly changing population of HCV-infected individuals needs to evaluate how DAA therapy affects PROs and elucidate which symptoms resolve with viral eradication.

UR - http://www.scopus.com/inward/record.url?scp=85050986439&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050986439&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0196908

DO - 10.1371/journal.pone.0196908

M3 - Article

C2 - 30067745

AN - SCOPUS:85050986439

VL - 13

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 8

M1 - e0196908

ER -