1. FDA-approved all oral DAA regimens show high cure rate for hepatitis C
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FDA-approved oral direct-acting antiviral (DAA) regimens produce high sustained virologic response (SVR) rates for all six hepatitis C virus (HCV) genotypes and for patient populations historically considered difficult to cure. The ease of dosing, safety profile, and effectiveness of DAAs provide an opportunity to reduce the burden of hepatitis C in the United States, provided barriers to care are addressed. The results of a systematic evidence review are published in Annals of Internal Medicine.
Researchers at Johns Hopkins University School of Medicine in Baltimore, MD, reviewed data from 42 published clinical trials of adults with chronic HCV infection that evaluated at least 8 weeks of an interferon-free HCV regimen that included at least 2 FDA-approved DAAs. These included inhibitors of HCV NS3 protease (grazoprevir, paritaprevir, and simeprevir); NS5A (daclatasvir, elbasvir, ledipasvir, ombitasvir, and velpatasvir); and NS5B polymerase (sofosbuvir and dasabuvir), as well as the oral antiviral ribavirin. Six DAA regimens showed SVR rates of greater than 95 percent in patients with HCV genotype 1 without cirrhosis, including those with HIV co-infection. Cure rates were similar for the remaining genotypes of HCV, although fewer regimens were effective for genotype 2.
The authors of an accompanying editorial suggest that these findings provide hope that HCV is now fully treatable and can potentially be eliminated as an important medical problem in the United States. While HCV is now easy to treat, there are still some issues, such as cost and access to care, which need to be addressed.
Media contacts: For an embargoed PDF, please contact Cara Graeff. The lead author, Oluwaseun Falade-Nwulia, MBBS, MPH at Johns Hopkins, can be contacted directly at email@example.com.
2. A single glucocorticoid injection provides only short-term relief from chronic low back pain
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A single intradiscal glucocorticoid injection reduces low back pain associated with active discopathy at 1 month for patients in which first-line conservative treatments had failed. However, the effect decreased over time. The results of a randomized trial are published in Annals of Internal Medicine.
Researchers conducted a prospective, parallel-group, double-blind, randomized, controlled study at 3 tertiary care centers in France with expertise in managing spinal disorders to assess the efficacy of a single glucocorticoid intradiscal injection in patients with chronic low back pain with active discopathy. Participants with chronic low back pain with active discopathy were randomly assigned to a single intradiscal glucocorticoid injection during discography (n = 67) or discography alone (n = 68). The patients were asked to rate their lower back pain severity 48 hours before the intervention and at 1, 3, 6, and 12 months. Patients who received a single intradiscal glucocorticoid injection reported positive effects on pain at 1 month compared with the control group. The effect decreased over time with no differences in low back pain intensity between groups at 12 months.
Active discopathy is associated with a specific phenotype of chronic low back pain. Local inflammation has a role in active discopathy-associated symptoms. As such it makes sense to evaluate treatments that target local inflammation, such as glucocorticoid intradiscal injections. However, given these findings, the researchers question the efficacy of glucocorticoid injections as a treatment for chronic low back pain.
Media contacts: For an embargoed PDF or author contact information, please contact Cara Graeff.
Also new in this issue:
Clinical Trials of Therapeutics for the Prevention of Congenital Zika Virus Disease: Challenges and Potential Solutions
Alex P. Salam, MBChB, MSc; Amanda Rojek, MBBS, MSc; Jake Dunning, MBBS, PhD; and Peter W. Horby, MBBS PhD
Research and Reporting Methods
Inpatient Notes: What Do French Wine and Hospital Infections Have in Common?
Payal K. Patel, MD, MPH, and Sanjay Saint, MD, MPH
Annals for Hospitalists