Toward more widespread use of novel drug therapies Current status of interferon therapy in patients with hepatitis C and discussion of strategies to propagate its use
Yumiko Nagao*, Michio Sata*, Fumio Suzuki, Haruhiko Nobayashi and Yutaka Kawakami
No.32 : August 2006
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*Department of Digestive Disease Information & Research, Kurume University School of Medicine Figures to be hyperlinked from [Figure 1-5] in the text.
Background
The potential of even the best medicines cannot be realized until their use is widespread. However, it is not always easy to popularize novel drug therapies, as typified by interferon (IFN) therapy for chronic hepatitis C (CHC). The purpose of this study was to investigate the current status of use of IFN therapy for hepatitis C and to devise community healthcare strategies to propagate its use so that a larger number of patients can benefit from this novel therapy.
Methods
A questionnaire survey was carried out on 254 outpatients with hepatitis C virus (HCV) infection attending eight medical institutions in the same geographical area of Japan. A questionnaire designed for patients was answered by the patients themselves, while another designed for physicians was answered by their doctors. One of the eight institutions is a community hospital with full-time hepatologists, while the other seven are primary health care clinics with no hepatologists. Patients in their 70s constituted the largest group (40.2%) of patients, followed by those in their 60s (26.4%) and in their 50s (16.9%), in that order. The most common type of liver disease was CHC (74.4%), followed by hepatic cirrhosis (18.5%). Among the 254 patients, 101 attended a hospital, while the remaining 153 visited clinics.
Results
Analysis of the responses of the physicians to the questionnaire survey revealed that 61.0% and 59.1% of the patients, respectively, had been explained about and recommended IFN therapy, and that the proportion of patients with a history of receiving IFN therapy in this geographic area of Japan was 40.6% [Figure 1,Figure 2]. The results of analysis of the patients' responses to the questionnaire were consistent with those of the physicans' responses. Among the patients who had no history of receiving IFN therapy, 67.8%, according to the responses of the patients themselves, had not been encouraged by their physicians to receive IFN therapy [Figure 3]. Of the 32 patients who had refused IFN therapy, 24 (75.0%) worried about the side effects of the therapy, which thus constituted the most frequent reason for refusal.
Stratified analyses of the physicians' answers by the type of institution showed that 78.2% of patients attending the hospital ("Hospital Patients") gave a history of receiving IFN therapy, while only 15.7% of the patients attending clinics ("Clinic Patients") gave a history of receiving IFN therapy [Figure 4]. Furthermore, the proportions of patients who had received an explanation about IFN therapy at the hospital and at the clinics were 88.1% and 43.1%, respectively. Similarly, IFN therapy was recommended to 90.1% of the "Hospital Patients" but only 38.6% of the "Clinic Patients" had been recommended IFN therapy by their physicians [Figure 5].
The percentage of patients whose answers about being explained about IFN therapy or recommended IFN therapy tallied with those of their physicians was 71.3% and 69.1%, respectively. The respective percentages for "Hospital Patients" were 93.1% and 85.7%, respectively, and those for "Clinic patients" were 56.9% and 66.1%, respectively.
Discussion
The proportion of patients with a history of receiving IFN therapy (40.6%) in this survey was higher than that reported from a national survey (5.1%), and yet IFN therapy can be carried out in more patients infected with HCV in this region, given that a virologic response had been achieved in 47.8% of the patients with experience of IFN .
Lack of experience of IFN therapy in the patients was principally attributed to a lack of explanation about or recommendation of IFN therapy by the physicians, with significant differences in the frequency of both between hepatologists and non-hepatologists. The reasons for the physicians not encouraging the patients to receive IFN therapy were: 1) the patients were elderly, 2) they had advanced liver disease, and 3) they often had complications.
In order for more patients to receive IFN therapy, it is important for physicians to make further efforts at increasing the patients' understanding of the therapy with accurate, easy-to-understand explanations, and recommending the treatment to the patients, that is, the quality of communications between patients and physicians needs improvement. Furthermore, building of a closer partnership between hepatologists and non-hepatologists in the region also needs to be discussed.