簡化的 HCV 治療模式：臨床實踐的經驗教訓

StephenW

簡化的 HCV 治療模式：臨床實踐的經驗教訓

cey Trooskin, MD, PhD, MPH
首席醫療官
費城 FIGHT 社區健康中心
學院
傳染病科
佩雷爾曼醫學院
賓夕法尼亞大學
賓夕法尼亞州費城




簡化我們的治療方法使提供者和患者可以獲得丙型肝炎治療。在我看來，丙肝治療現在如此簡單，以至於治療丙肝比治療糖尿病甚至高血壓都容易。通過遵循簡化的治療算法，初級保健提供者可以輕鬆治療和治愈慢性丙型肝炎病毒感染患者。

什麼是簡化的 HCV 治療模式？
美國肝病研究協會/美國傳染病學會推薦的丙型肝炎簡化治療模式以使用泛基因型方案為中心：glecaprevir/pibrentasvir 或 sofosbuvir/velpatasvir。這些藥物適用於所有基因型。

一種簡化的治療模式可用於沒有失代償期肝硬化病史且以前未接受過治療的慢性丙型肝炎成人。進行治療前實驗室測試，然後在治療結束後 12 週完成治療後的治愈評估。不需要治療中的實驗室監測。

哪些患者需要不同的方法？
一些患者可能需要更多的支持和更頻繁的隨訪。 HCV 治療指南建議，不應將簡化的治療模式用於既往有 HCV 治療經驗、患有 HIV 或乙型肝炎病毒合併感染、懷孕、患有終末期腎病、患有肝細胞癌、當前或既往失代償的個體，或接受過肝移植。

我們如何進一步簡化 HCV 治療？
本著最真實的精神，簡化 HCV 治療方法的下一步是測試和治療模型，我們可以在其中診斷個人並在同一天開始治療。在美國，許多州仍然要求付款人事先授權進行 HCV 治療。這意味著開藥者必須向保險公司提交申請，證明患者符合某些標準，然後保險公司需要批准藥物。周轉時間可以是 24 小時到 2 週不等，具體取決於系統的效率。對於提供者來說，這可能是一個障礙，因為要為我們的患者進行治療需要大量文書工作和繁文縟節。

對於大多數其他慢性疾病，我們不需要這樣做。例如，如果有人被診斷出患有高血壓，我們會讓他們開始服藥，他們會在同一天拿到處方。儘管一些州已經取消了在其醫療補助計劃中事先授權 HCV 治療的需要，但這在許多情況下繼續使處方復雜化。

簡化我們的治療方法使提供者和患者可以獲得丙型肝炎治療。在我看來，丙肝治療現在如此簡單，以至於治療丙肝比治療糖尿病甚至高血壓都容易。通過遵循簡化的治療算法，初級保健提供者可以輕鬆治療和治愈慢性丙型肝炎病毒感染患者。

什麼是簡化的 HCV 治療模式？
美國肝病研究協會/美國傳染病學會推薦的丙型肝炎簡化治療模式以使用泛基因型方案為中心：glecaprevir/pibrentasvir 或 sofosbuvir/velpatasvir。這些藥物適用於所有基因型。

一種簡化的治療模式可用於沒有失代償期肝硬化病史且以前未接受過治療的慢性丙型肝炎成人。進行治療前實驗室測試，然後在治療結束後 12 週完成治療後的治愈評估。不需要治療中的實驗室監測。

哪些患者需要不同的方法？
一些患者可能需要更多的支持和更頻繁的隨訪。 HCV 治療指南建議，不應將簡化的治療模式用於既往有 HCV 治療經驗、患有 HIV 或乙型肝炎病毒合併感染、懷孕、患有終末期腎病、患有肝細胞癌、當前或既往失代償的個體，或接受過肝移植。
我們如何進一步簡化 HCV 治療？
本著最真實的精神，簡化 HCV 治療方法的下一步是測試和治療模型，我們可以在其中診斷個人並在同一天開始治療。在美國，許多州仍然要求付款人事先授權進行 HCV 治療。這意味著開藥者必須向保險公司提交申請，證明患者符合某些標準，然後保險公司需要批准藥物。周轉時間可以是 24 小時到 2 週不等，具體取決於系統的效率。對於提供者來說，這可能是一個障礙，因為要為我們的患者進行治療需要大量文書工作和繁文縟節。

對於大多數其他慢性疾病，我們不需要這樣做。例如，如果有人被診斷出患有高血壓，我們會讓他們開始服藥，他們會在同一天拿到處方。儘管一些州已經取消了在其醫療補助計劃中事先授權 HCV 治療的需要，但這在許多情況下繼續使處方復雜化。一旦我們消除了這一點，我們就會更接近於為每個人設計的簡化模型的真正本質。

StephenW

The Simplified HCV Treatment Model: Lessons From Clinical Practice


Stacey Trooskin, MD, PhD, MPH
Chief Medical Officer
Philadelphia FIGHT Community Health Centers
Faculty
Division of Infectious Diseases
Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania


Chief Medical Officer
Philadelphia FIGHT Community Health Centers
Faculty
Division of Infectious Diseases
Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania

       
       

Simplifying our approach to treatment makes hepatitis C treatment accessible to providers and to patients. In my opinion, hepatitis C treatment is now so simple that it’s easier to treat hepatitis C than it is to treat diabetes, or even hypertension. By following a simplified treatment algorithm, primary care providers can easily treat and cure their patients with chronic hepatitis C virus infection.

What Is the Simplified HCV Treatment Model?
The simplified treatment model for hepatitis C recommended by the American Association for the Study of Liver Diseases/Infectious Diseases Society of America is centered on the use of pangenotypic regimens: either glecaprevir/pibrentasvir or sofosbuvir/velpatasvir. These medications work across all genotypes.

A simplified treatment model can be used in adults with chronic hepatitis C who do not have a history of decompensated cirrhosis and have not previously been treated. Pretreatment laboratory testing is conducted, and then a posttreatment assessment of cure is completed 12 weeks after the end of treatment. On-treatment laboratory monitoring is not required.

Which Patients Need a Different Approach?
Some patients may need more support and more frequent follow-up. HCV treatment guidelines advise that a simplified treatment model should not be used with individuals who have previous experience with HCV treatment, have HIV or hepatitis B virus coinfection, are pregnant, have end-stage renal disease, have hepatocellular carcinoma, have current or previous decompensation, or have undergone liver transplantation.

How Can We Simplify HCV Treatment Further?
In the truest spirit, the next step to a simplified HCV treatment approach is a test-and-treat model where we can diagnose an individual and begin treatment the same day. In the United States, many states still require prior authorization of HCV treatment from the payer. This means that the prescriber must submit a request to the insurance company demonstrating that the patient fits certain criteria, and then the insurance company needs to approve the medication. Turnaround time can be anywhere from 24 hours to 2 weeks depending on how efficient the system is. For providers, that can be a barrier because it’s a lot of paperwork and red tape to navigate to get our patients treated.

We don’t need to do that for most other chronic illnesses. For example, if someone is diagnosed with hypertension, we get them started on their medicine and they pick up their prescription the same day. Although several states have already removed the need for prior authorization of HCV treatment in their Medicaid programs, this continues to complicate prescribing in many settings.

Simplifying our approach to treatment makes hepatitis C treatment accessible to providers and to patients. In my opinion, hepatitis C treatment is now so simple that it’s easier to treat hepatitis C than it is to treat diabetes, or even hypertension. By following a simplified treatment algorithm, primary care providers can easily treat and cure their patients with chronic hepatitis C virus infection.

What Is the Simplified HCV Treatment Model?
The simplified treatment model for hepatitis C recommended by the American Association for the Study of Liver Diseases/Infectious Diseases Society of America is centered on the use of pangenotypic regimens: either glecaprevir/pibrentasvir or sofosbuvir/velpatasvir. These medications work across all genotypes.

A simplified treatment model can be used in adults with chronic hepatitis C who do not have a history of decompensated cirrhosis and have not previously been treated. Pretreatment laboratory testing is conducted, and then a posttreatment assessment of cure is completed 12 weeks after the end of treatment. On-treatment laboratory monitoring is not required.

Which Patients Need a Different Approach?
Some patients may need more support and more frequent follow-up. HCV treatment guidelines advise that a simplified treatment model should not be used with individuals who have previous experience with HCV treatment, have HIV or hepatitis B virus coinfection, are pregnant, have end-stage renal disease, have hepatocellular carcinoma, have current or previous decompensation, or have undergone liver transplantation.
How Can We Simplify HCV Treatment Further?
In the truest spirit, the next step to a simplified HCV treatment approach is a test-and-treat model where we can diagnose an individual and begin treatment the same day. In the United States, many states still require prior authorization of HCV treatment from the payer. This means that the prescriber must submit a request to the insurance company demonstrating that the patient fits certain criteria, and then the insurance company needs to approve the medication. Turnaround time can be anywhere from 24 hours to 2 weeks depending on how efficient the system is. For providers, that can be a barrier because it’s a lot of paperwork and red tape to navigate to get our patients treated.

We don’t need to do that for most other chronic illnesses. For example, if someone is diagnosed with hypertension, we get them started on their medicine and they pick up their prescription the same day. Although several states have already removed the need for prior authorization of HCV treatment in their Medicaid programs, this continues to complicate prescribing in many settings. Once we do away with that, we'll be getting closer to the true essence of a simplified model for everybody.