https://hal-univ-rennes1.archives-ouvertes.fr/hal-02050395/document

Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study

Direct antiviral agents (DAAs) - A new age in the treatment of hepatitis C virus infection.

Chronic HCV infections represent a major worldwide public health problem and are responsible for a large proportion of liver related deaths, mostly because of HCV-associated hepatocellular carcinoma and cirrhosis. The treatment of HCV has undergone a rapid and spectacular revolution. In the past 5 years, the launch of direct acting antiviral drugs has seen sustained virological response rates reach 90% and above for many patient groups. The new treatments are effective, well tolerated, allow for shorter treatment regimens and offer new opportunities for previously excluded groups. This therapeutic revolution has changed the rules for treatment of HCV, moving the field towards an interferon-free era and raising the prospect of HCV eradication. This manuscript addresses the new challenges regarding treatment optimisation in the real world, improvement of antiviral efficacy in ‘hard-to-treat’ groups, the management of patients whose direct acting antiviral drug treatment was unsuccessful, and access to diagnosis and treatment in different parts of the world.

https://gut.bmj.com/content/gutjnl/64/11/1824.full.pdf

Hepatitis C virus treatment in the real world: optimising treatment and access to therapies

Current therapy for chronic hepatitis C: The role of direct-acting antivirals.

SummaryBackground
Treatment of chronic hepatitis C using combination of sofosbuvir (SOF) and daclatasvir (DCV) was used in several clinical trials and multicentre studies, which were somewhat limited to genotypes 1-3. The national program in Egypt is using SOF-DCV combination for large scale treatment.

Aim
To assess the efficacy and safety of combined SOF-DCV in treating patients with HCV-G4 in a real-world setting.

Methods
Data and outcome of chronic HCV patients who were treated for 12 weeks with generic medications: DCV 60 mg plus SOF 400 mg ± ribavirin (RBV) within the national hepatitis C treatment program in Egypt are presented. Treatment-naive patients without cirrhosis were treated without RBV, and those who had cirrhosis or were treatment-experienced (interferon experienced or SOF experienced) received RBV. Efficacy and safety were assessed, and baseline factors associated with sustained virological response at post-treatment week 12 (SVR12) were explored.

Results
During the first 2 months of the programme, 18 378 patients with HCV-G4 started treatment with SOF-DCV with or without RBV. Overall, 95.1% achieved SVR12 (95.4% among patients treated without RBV and 94.7% for patients treated with RBV, P = .32). Treatment was prematurely discontinued in only 1.5% of patients. The most common events leading to discontinuation were patient withdrawal (n = 76) and pregnancy (n = 5). Five deaths occurred within this group.

Conclusions
Real-world experience of generic SOF-DCV in patients with chronic HCV-G4 proved to be safe and associated with a high SVR12 rate, in patients with different stages of fibrosis.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/apt.14428

Generic daclatasvir plus sofosbuvir, with or without ribavirin, in treatment of chronic hepatitis C: real-world results from 18 378 patients in Egypt.

https://hal-univ-rennes1.archives-ouvertes.fr/hal-01435007/document

Safety and efficacy of daclatasvir-sofosbuvir in HCV genotype 1-mono-infected patients.

Postpartum hemorrhage (PPH) is a major component of perinatal morbidity and mortality affecting young women worldwide, and is still often unpredictable. Reducing the incidence of PPH is a major health issue, and identifying women at risk for PPH is a key element in preventing this complication.To estimate PPH prevalence after vaginal delivery and to identify PPH risk factors.Unselected pregnant women ≥ 16 years attending one of six maternity wards in Brittany (France) for vaginal birth after 15 weeks of gestation were recruited in this prospective multicenter cohort study between June 1, 2015 and January 31, 2019. PPH was defined as a blood loss ≥ 500 mL in the 24 hours following delivery. Independent risk factors for PPH were determined by logistic regression. Missing data were compensated by multiple imputation (MICE method).Among 16,382 included women, PPH prevalence was 5.37%. A first-degree family history of PPH (aOR = 1.63, 95%CI 1.24-2.14) and a personal transfusion history (aOR = 1.90, 95%CI 1.23-2.92) were significantly associated with PPH. The use of oxytocin during labor was also a risk factor for PPH (aOR = 1.24, 95%CI 1.06-1.44). Inversely, smoking during pregnancy and intrauterine growth restriction were associated with a reduced risk of PPH (aOR = 0.76, 95%CI 0.63-0.91, and 0.34, 95%CI 0.13-0.87, respectively).In addition to classical risk factors, this study identified PPH family history and personal transfusion history as new characteristics associated with PPH after vaginal delivery. The association of PPH with a family history of PPH suggests a hereditary hemorrhagic phenotype and calls for genetic studies. Identifying women at risk for PPH is a key element in being prepared for this complication. 

Family history of postpartum hemorrhage is a risk factor for postpartum hemorrhage after vaginal delivery: results from the French prospective multicenter HEMOTHEPP cohort study.

Sandy Lucier

Papers

Safety and efficacy of daclatasvir-sofosbuvir in HCV genotype 1-mono-infected patients.

Family history of postpartum hemorrhage is a risk factor for postpartum hemorrhage after vaginal delivery: results from the French prospective multicenter HEMOTHEPP cohort study.