Avaluació del treball en equip multidisciplinari en el tractament de pacientes amb hepatitis crònica per virus C

Abstract

Hepatitis C is one of the leading causes of chronic liver disease in the world. Liver injury can range from minimal histological changes to cirrhosis and its complications and hepatocellular carcinoma. Currently, the incidence and prevalence of liver disease due to the hepatitis C virus (HCV) is declining due to the efficacy of the new direct-acting antiviral agents (DAA)._x000D_ Until 2015, chronic HCV hepatitis was treated with pegylated interferon and ribavirin. It was associated with a high rate of adverse effects and a decreased quality of life, so it was contraindicated in many patients. It required a lot of controls, so monitoring within a multidisciplinary team could improve the undesirable effects, which is why the first study of the thesis was done. However, from 2015 onwards, DAA could be used, which have very few side effects. Pivotal studies suggested that they were safe for patients with psychiatric pathology, however, their effects on anxiety and depression had not been specifically analyzed so we wanted to analyze these effects in clinical practice._x000D_ _x000D_ The aim of the first study was to determine whether implementing a multidisciplinary team improved the outcomes of the treatment of chronic HCV hepatitis. In the second study, the main objective was to analyze anxiety and depression in patients with chronic HCV hepatitis treated with DAA during the treatment period and until a sustained viral response (SVR) was obtained._x000D_ _x000D_ The first study analyzed patients treated with pegylated interferon plus ribavirin between August 2001 and December 2011. Patients treated before and after the multidisciplinary team in 2007 were compared. Demographic and clinical characteristics and laboratory outcomes were compared between a control group and an intervention group managed by a multidisciplinary team. A multivariate logistic regression model was used to evaluate the effect of the multidisciplinary team. The second study included all patients who began treatment with DAA between November 1, 2014 and October 31, 2015. They filled out the HADS questionnaire at different times during treatment and upon reaching the SVR. The results were evaluated using a linear regression model with repeated measurements._x000D_ _x000D_ The first study included 514 patients (228 (44.4%) in the control group -without the intervention of the multidisciplinary team-). Prognostic factors for SVR were age, genotype, pretreatment, AST, ferritin, and triglycerides. After adjusting for prognostic factors, SVR was higher in the intervention cohort (with the multidisciplinary team) than in the control group (58% vs. 48%, p = 0.038). The dropout rate was 2.2% in the intervention group vs. 4.9% in the control group p = 0.107 despite greater psychiatric comorbidity in the intervention group. The second study included 145 patients treated with DAA (11% of them with severe psychiatric disorders; 32% with psychiatric treatment). The SVR was 97.3%. Anxiety and depression scores did not differ during treatment or follow-up. No significant differences were found in the analysis of the different subgroups (significant fibrosis or cirrhosis, major psychiatric disorder, ribavirin association)._x000D_ _x000D_ Multidisciplinary team management of patients with chronic HCV hepatitis improves SVR and decreases the rate of discontinuation of treatment with pegylated interferon and ribavirin. DAA treatment has no impact on anxiety or depression during or after treatment, even in high-risk patients with severe psychiatric disorders.

Date of Award	15 Jan 2021
Original language	Catalan
Supervisor	Mercedes Vergara Gomez (Director)