Hepatitis C-vírus-ferto{combining double acute accent}zés: Diagnosztika, antivirális terápia, kezelés utáni gondozás: Magyar konszenzusajánlás

Translated title of the contribution: Diagnosis, treatment, and follow-up of hepatitis C virus related liver disease: Hungarian national consensus guideline

B. Hunyady, Zsuzsanna Gerlei, Judit Gervain, Gábor Horváth, G. Lengyel, A. Pár, László Rókusz, F. Szalay, L. Telegdy, István Tornai, Klára Werling, Mihály Makara

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Approximately 70 000 people are infected with hepatitis C virus in Hungary, and more than half of them are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy. From a socioeconomic aspect, this could also prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can clear the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained viral response to 63-75% and 59-66%, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antiviral interferon-free combination therapies have been registered for the treatment of chronic hepatitis C, with a potential efficacy over 90% and typical short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and / or fibrosis in the liver. Non-invasive methods (elastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment as well as for on-treatment decisions, accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations therapy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent need based on a Hungarian Priority Index system reflecting primarily the stage of liver disease, and considering also additional factors, i.e., activity and progression of liver disease, predictive factors of treatment and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained viral response value in different patient categories with consensus between professional organizations, National Health Insurance Fund and patient organizations. More expensive therapies might be available upon co-financing by the patient or a third party. Interferon-free treatments and shorter therapy durations preferred as much as financially feasible. A separate budget is allocated to cover interferon-free treatments for the most-in-need interferon ineligible/intolerant patients, and for those who have no more interferon-based therapy option.

Original languageHungarian
Pages (from-to)3-23
Number of pages21
JournalOrvosi Hetilap
Volume156
DOIs
Publication statusPublished - Mar 1 2015

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Hepacivirus
Liver Diseases
Guidelines
Interferons
Therapeutics
Liver Cirrhosis
Hungary
National Health Programs
Budgets
Protease Inhibitors
Viruses
Elasticity Imaging Techniques
Costs and Cost Analysis
Ribavirin
Liver
Liver Failure
Wounds and Injuries
Chronic Hepatitis C
Liver Neoplasms
Life Expectancy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Hepatitis C-vírus-ferto{combining double acute accent}zés : Diagnosztika, antivirális terápia, kezelés utáni gondozás: Magyar konszenzusajánlás. / Hunyady, B.; Gerlei, Zsuzsanna; Gervain, Judit; Horváth, Gábor; Lengyel, G.; Pár, A.; Rókusz, László; Szalay, F.; Telegdy, L.; Tornai, István; Werling, Klára; Makara, Mihály.

In: Orvosi Hetilap, Vol. 156, 01.03.2015, p. 3-23.

Research output: Contribution to journalArticle

Hunyady, B. ; Gerlei, Zsuzsanna ; Gervain, Judit ; Horváth, Gábor ; Lengyel, G. ; Pár, A. ; Rókusz, László ; Szalay, F. ; Telegdy, L. ; Tornai, István ; Werling, Klára ; Makara, Mihály. / Hepatitis C-vírus-ferto{combining double acute accent}zés : Diagnosztika, antivirális terápia, kezelés utáni gondozás: Magyar konszenzusajánlás. In: Orvosi Hetilap. 2015 ; Vol. 156. pp. 3-23.
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abstract = "Approximately 70 000 people are infected with hepatitis C virus in Hungary, and more than half of them are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy. From a socioeconomic aspect, this could also prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can clear the virus in 40-45{\%} of previously not treated (na{\"i}ve), and in 5-21{\%} of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained viral response to 63-75{\%} and 59-66{\%}, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antiviral interferon-free combination therapies have been registered for the treatment of chronic hepatitis C, with a potential efficacy over 90{\%} and typical short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and / or fibrosis in the liver. Non-invasive methods (elastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment as well as for on-treatment decisions, accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations therapy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent need based on a Hungarian Priority Index system reflecting primarily the stage of liver disease, and considering also additional factors, i.e., activity and progression of liver disease, predictive factors of treatment and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained viral response value in different patient categories with consensus between professional organizations, National Health Insurance Fund and patient organizations. More expensive therapies might be available upon co-financing by the patient or a third party. Interferon-free treatments and shorter therapy durations preferred as much as financially feasible. A separate budget is allocated to cover interferon-free treatments for the most-in-need interferon ineligible/intolerant patients, and for those who have no more interferon-based therapy option.",
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AB - Approximately 70 000 people are infected with hepatitis C virus in Hungary, and more than half of them are not aware of their infection. From the point of infected individuals early recognition and effective treatment of related liver injury may prevent consequent advanced liver diseases and complications (liver cirrhosis, liver failure and liver cancer) and can increase work productivity and life expectancy. From a socioeconomic aspect, this could also prevent further spread of the virus as well as reduce substantially long term financial burden of related morbidity. Pegylated interferon + ribavirin dual therapy, which is available in Hungary since 2003, can clear the virus in 40-45% of previously not treated (naïve), and in 5-21% of previous treatment-failure patients. Addition of a direct acting first generation protease inhibitor drug (boceprevir or telaprevir) to the dual therapy increases the chance of sustained viral response to 63-75% and 59-66%, respectively. These two protease inhibitors are available and financed for a segment of Hungarian patients since May 2013. Between 2013 and February 2015, other direct acting antiviral interferon-free combination therapies have been registered for the treatment of chronic hepatitis C, with a potential efficacy over 90% and typical short duration of 8-12 weeks. Indication of therapy includes exclusion of contraindications to the drugs and demonstration of viral replication with consequent liver injury, i.e., inflammation and / or fibrosis in the liver. Non-invasive methods (elastography and biochemical methods) are accepted and preferred for staging liver damage (fibrosis). For initiation of treatment as well as for on-treatment decisions, accurate and timely molecular biology tests are mandatory. Eligibility for treatment is a subject of individual central medical review. Due to budget limitations therapy is covered only for a proportion of patients by the National Health Insurance Fund. Priority is given to those with urgent need based on a Hungarian Priority Index system reflecting primarily the stage of liver disease, and considering also additional factors, i.e., activity and progression of liver disease, predictive factors of treatment and other special issues. Approved treatments are restricted to the most cost-effective combinations based on the cost per sustained viral response value in different patient categories with consensus between professional organizations, National Health Insurance Fund and patient organizations. More expensive therapies might be available upon co-financing by the patient or a third party. Interferon-free treatments and shorter therapy durations preferred as much as financially feasible. A separate budget is allocated to cover interferon-free treatments for the most-in-need interferon ineligible/intolerant patients, and for those who have no more interferon-based therapy option.

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KW - Hepatitis C virus

KW - Hepatocellular cancer

KW - Interferon

KW - Ledipasvir

KW - Liver cirrhosis

KW - Ombitasvir

KW - Paritaprevir

KW - Pegylated interferon

KW - Polimerase-inhibitor

KW - Protease-inhibitor

KW - Ribavirin

KW - Ritonavir

KW - Simeprevir

KW - Sofosbuvir

KW - Telaprevir

KW - Viral hepatitis

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