1. Research supports removing drug use as a restriction for receiving highly curative hep C treatment
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Hep C patients being treated for opioid addiction achieved high rates of sustained virologic response after 12 weeks of therapy with elbasvir-grazoprevir compared to those taking placebo for 12 weeks before beginning the drug treatment. The patients in the elbasvir-grazoprevir group saw a reduced viral load, regardless of ongoing drug use. The results of a randomized, controlled trial are published in Annals of Internal Medicine.
Up to 170 million people worldwide have hepatitis C virus (HCV) infection and injection drug use is a major risk factor. While the once-daily dosing, low side-effects profile, and shortened treatment duration of interferon-free direct-acting antivirals are ideal for injection drug users, most trials of these therapies for HCV have excluded persons with recent injection drug use.
The CO-STAR (Hepatitis C Patients on Opioid Substitution Therapy Antiviral Response) trial sought to evaluate the efficacy and safety of elbasvir-grazoprevir for injection drug users. Researchers assigned 301 treatment-naive patients with chronic HCV genotype 1, 4, or 6 infection who were at least 80 percent adherent to visits for opioid-agonist therapy to immediate treatment with elbasvir-grazoprevir for 12 weeks, or deferred treatment with placebo for 12 weeks, then open-label elbasvir-grazoprevir for 12 weeks. They found that 91.5 percent of the patients in the immediate treatment group achieved sustained virologic response, regardless of ongoing drug use. According to the authors, these results suggest that drug use should be removed as a barrier to interferon-free HCV therapy for patients being treated for opioid addiction.
Note: For an embargoed PDF, please contact Cara Graeff. To reach the lead author, Dr. Gregory Dore, please contact Lucienne Bamford at Lbamford@kirby.unsw.edu.au.
2. Evidence lacking to evaluate the benefits and harms of lipid screening in younger adults
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Investigators for the U.S. Preventive Services Task Force (USPSTF) found a lack of evidence on the benefits and harms of screening for lipid disorders, or dyslipidemia, in younger adults. Their report is published in Annals of Internal Medicine.
More than half of U.S. adults are affected by lipid disorders, which are associated with cardiovascular disease. While dyslipidemia becomes more prevalent with age, it also affects younger adults. Since dyslipidemia it is asymptomatic before cardiovascular disease develops, early detection with screening could allow for young adults to implement prevention strategies to reduce their risk for cardiovascular events.
In 2008, the USPSTF recommended lipid screening in men aged 20 to 35 and women aged 20 to 45 years with CHD risk factors. Although the USPSTF found no direct evidence regarding benefits or harms of lipid screening within these age groups, its recommendation was based on data showing that some younger adults with CHD risk factors have lipid levels sufficient to place them at high 10-year cardiovascular risk and might benefit from lipid-lowering therapies. The purpose of this review was to update previous USPSTF reviews on screening for dyslipidemia in younger adults. The USPSTF did not re-review evidence on screening for dyslipidemia for older adults because it already strongly recommends screening in men older than 35 and women older than 45.
In their review, the researchers found no direct evidence regarding benefits and harms of dyslipidemia screening or treatment in younger adults. They conclude that estimating the potential effects of screening for dyslipidemia in a younger population will require extrapolation from studies performed in older adults.
Note: For an embargoed PDF, please contact Cara Graeff. The lead author, Dr. Roger Chou, can be reached through Ariane Holm Le Chevallier at email@example.com or 503-494-4158.
Also in this issue:
Human Trafficking: The Role of Medicine in Interrupting the Cycle of Abuse and Violence
Wendy Macias-Konstantopoulos, MD, MPH
Medicine and Public Issues
Annals of Internal Medicine