TY  - JOUR
A1  - Wilde, Anne-Christin Beatrice
A1  - Lieb, Charlotte
A1  - Leicht, Elise
A1  - Greverath, Lena Maria
A1  - Steinhagen, Lara Marleen
A1  - Wald de Chamorro, Nina
A1  - Petersen, Jörg
A1  - Hofmann, Wolf Peter
A1  - Hinrichsen, Holger
A1  - Heyne, Renate
A1  - Berg, Thomas
A1  - Naumann, Uwe
A1  - Schwenzer, Jeannette
A1  - Vermehren, Johannes
A1  - Geier, Andreas
A1  - Tacke, Frank
A1  - Müller, Tobias
T1  - Real-world clinical management of patients with primary biliary cholangitis — a retrospective multicenter study from Germany
JF  - Journal of Clinical Medicine
N2  - Background: Clinical practice guidelines for patients with primary biliary cholangitis (PBC) have been recently revised and implemented for well-established response criteria to standard first-line ursodeoxycholic acid (UDCA) therapy at 12 months after treatment initiation for the early identification of high-risk patients with inadequate treatment responses who may require treatment modification. However, there are only very limited data concerning the real-world clinical management of patients with PBC in Germany. Objective: The aim of this retrospective multicenter study was to evaluate response rates to standard first-line UDCA therapy and subsequent Second-line treatment regimens in a large cohort of well-characterized patients with PBC from 10 independent hepatological referral centers in Germany prior to the introduction of obeticholic acid as a licensed second-line treatment option. Methods: Diagnostic confirmation of PBC, standard first-line UDCA treatment regimens and response rates at 12 months according to Paris-I, Paris-II, and Barcelona criteria, the follow-up cut-off alkaline phosphatase (ALP) ≤ 1.67 × upper limit of normal (ULN) and the normalization of bilirubin (bilirubin ≤ 1 × ULN) were retrospectively examined between June 1986 and March 2017. The management and hitherto applied second-line treatment regimens in patients with an inadequate response to UDCA and subsequent response rates at 12 months were also evaluated. Results: Overall, 480 PBC patients were included in this study. The median UDCA dosage was 13.2 mg UDCA/kg bodyweight (BW)/d. Adequate UDCA treatment response rates according to Paris-I, Paris-II, and Barcelona criteria were observed in 91, 71.3, and 61.3% of patients, respectively. In 83.8% of patients, ALP ≤ 1.67 × ULN were achieved. A total of 116 patients (24.2%) showed an inadequate response to UDCA according to at least one criterion. The diverse second-line treatment regimens applied led to significantly higher response rates according to Paris-II (35 vs. 60%, p = 0.005), Barcelona (13 vs. 34%, p = 0.0005), ALP ≤ 1.67 × ULN and bilirubin ≤ 1 × ULN (52.1 vs. 75%, p = 0.002). The addition of bezafibrates appeared to induce the strongest beneficial effect in this cohort (Paris II: 24 vs. 74%, p = 0.004; Barcelona: 50 vs. 84%, p = 0.046; ALP < 1.67 × ULN and bilirubin ≤ 1 × ULN: 33 vs. 86%, p = 0.001). Conclusion: Our large retrospective multicenter study confirms high response rates following UDCA first-line standard treatment in patients with PBC and highlights the need for close monitoring and early treatment modification in high-risk patients with an insufficient response to UDCA since early treatment modification significantly increases subsequent response rates of these patients.
KW  - primary biliary cholangitis
KW  - autoantibodies
KW  - ursodeoxycholic acid
KW  - treatment response
KW  - second line therapy
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234003
SN  - 2077-0383
VL  - 10
IS  - 5
ER  - 
TY  - JOUR
A1  - Graf, Christiana
A1  - Mondorf, Antonia
A1  - Knop, Viola
A1  - Peiffer, Kai-Henrik
A1  - Dietz, Julia
A1  - Friess, Julia
A1  - Wedemeyer, Heiner
A1  - Buggisch, Peter
A1  - Mauss, Stefan
A1  - Berg, Thomas
A1  - Rausch, Michael
A1  - Sprinzl, Martin
A1  - Klinker, Hartwig
A1  - Hinrichsen, Holger
A1  - Bronowicki, Jean-Pierre
A1  - Haag, Sebastian
A1  - Hüppe, Dietrich
A1  - Lutz, Thomas
A1  - Poynard, Thierry
A1  - Zeuzem, Stefan
A1  - Friedrich-Rust, Mireen
A1  - Sarrazin, Christoph
A1  - Vermehren, Johannes
T1  - Evaluation of point shear wave elastography using acoustic radiation force impulse imaging for longitudinal fibrosis assessment in patients with HBeAg-Negative HBV infection
JF  - Journal of Clinical Medicine
N2  - Background: Accurate assessment of hepatic fibrosis in patients with chronic HBeAg-negative Hepatitis B is of crucial importance not only to predict the long-term clinical course, but also to evaluate antiviral therapy indication. The aim of this study was to prospectively assess the utility of point shear wave elastography (pSWE) for longitudinal non-invasive fibrosis assessment in a large cohort of untreated patients with chronic HBeAg-negative hepatitis B virus (HBV) infection. Methods: 407 consecutive patients with HBeAg-negative HBV infection who underwent pSWE, transient elastography (TE) as well as laboratory fibrosis markers, including fibrosis index based on four factors (FIB-4), aspartate to platelet ratio index (APRI) and FibroTest, on the same day were prospectively followed up for six years. Patients were classified into one of the three groups: inactive carriers (IC; HBV-DNA <2000 IU/mL and ALT <40 U/L); grey zone group 1 (GZ-1; HBV DNA <2000 IU/mL and ALT >40 U/L); grey zone group 2 (GZ-2; HBV-DNA >2000 IU/mL and ALT <40 U/L). Results: pSWE results were significantly correlated with TE (r = 0.29, p < 0.001) and APRI (r = 0.17; p = 0.005). Median pSWE values did not differ between IC, GZ-1 and GZ-2 patients (p = 0.82, p = 0.17, p = 0.34). During six years of follow-up, median pSWE and TE values did not differ significantly over time (TE: p = 0.27; pSWE: p = 0.05). Conclusion: Our data indicate that pSWE could be useful for non-invasive fibrosis assessment and follow-up in patients with HBeAg-negative chronic HBV infection.
KW  - HBV
KW  - non-invasive fibrosis assessment
KW  - point shear wave elastography
KW  - acoustic radiation force impulse imaging
KW  - transient elastography
KW  - fibrotest
KW  - APRI
KW  - FIB-4
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-193916
SN  - 2077-0383
VL  - 8
IS  - 12
ER  - 
TY  - JOUR
A1  - Heidrich, Benjamin
A1  - Wiegand, Steffen B.
A1  - Buggisch, Peter
A1  - Hinrichsen, Holger
A1  - Link, Ralph
A1  - Möller, Bernd
A1  - Böker, Klaus H. W.
A1  - Teuber, Gerlinde
A1  - Klinker, Hartwig
A1  - Zehnter, Elmar
A1  - Naumann, Uwe
A1  - Busch, Heiner W.
A1  - Maasoumy, Benjamin
A1  - Baum, Undine
A1  - Hardtke, Svenja
A1  - Manns, Michael P.
A1  - Wedemeyer, Heiner
A1  - Petersen, Jörg
A1  - Cornberg, Markus
T1  - Treatment of Naive Patients with Chronic Hepatitis C Genotypes 2 and 3 with Pegylated Interferon Alpha and Ribavirin in a Real World Setting: Relevance for the New Era of DAA
JF  - PLOS ONE
N2  - Evidence based clinical guidelines are implemented to treat patients efficiently that include efficacy, tolerability but also health economic considerations. This is of particular relevance to the new direct acting antiviral agents that have revolutionized treatment of chronic hepatitis C. For hepatitis C genotypes 2/3 interferon free treatment is already available with sofosbuvir plus ribavirin. However, treatment with sofosbuvir-based regimens is 10-20 times more expensive compared to pegylated interferon alfa and ribavirin (PegIFN/RBV). It has to be discussed if PegIFN/RBV is still an option for easy to treat patients. We assessed the treatment of patients with chronic hepatitis C genotypes 2/3 with PegIFN/RBV in a real world setting according to the latest German guidelines. Overall, 1006 patients were recruited into a prospective patient registry with 959 having started treatment. The intention-to-treat analysis showed poor SVR (GT2 61%, GT3 47%) while patients with adherence had excellent SVR in the per protocol analysis (GT2 96%, GT3 90%). According to guidelines, 283 patients were candidates for shorter treatment duration, namely a treatment of 16 weeks (baseline HCV-RNA <800.000 IU/mL, no cirrhosis and RVR). However, 65% of these easy to treat patients have been treated longer than recommended that resulted in higher costs but not higher SVR rates. In conclusion, treatment with PegIFN/RBV in a real world setting can be highly effective yet similar effective than PegIFN +/- sofosbuvir/RBV in well-selected naive G2/3 patients. Full adherence to guidelines could be further improved, because it would be important in the new era with DAA, especially to safe resources.
KW  - peginterferon alpha-2B
KW  - HCV genotype-2
KW  - sofosbuvir
KW  - infection
KW  - epidemology
Y1  - 2014
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-115149
SN  - 1932-6203
VL  - 9
IS  - 10
ER  -