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RISS 인기검색어
- 검색키워드
- 저자 : ( Anand P. Chokkalingam ) (검색결과 3 건)
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( Ira Jacobson ),( Andrew J. Muir ),( Eric Lawitz ),( Edward Gane ),( Brian Conway ),( Peter J. Ruane ),( Ziad Younes ),( Frances Chen ),( Marianne Camargo ),( Anand P. Chokkalingam ),( C. Stephen Dje 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: In patients with HCV cirrhosis, a sustained virologic response (SVR) is associated with improved clinical outcomes; however, the temporal course of changes in fibrosis is poorly understood. Our aim was to evaluate changes in noninvasive tests of fibrosis (NITs) in this setting to gain insights into the natural history of cirrhosis regression following removal of the causative exposure. Methods: We studied patients with HCV cirrhosis who achieved SVR with sofosbuvir (SOF)-based regimens (in a trial or clinical practice) in an ongoing, prospective cirrhosis registry (NCT02292706). Patients underwent routine clinical and laboratory assessments, including semi-annual Child-Pugh-Turcotte (CPT) scoring and measurement of the Enhanced Liver Fibrosis (ELF) test, as well as annual liver stiffness measurement by transient elastography (LS by TE). Changes in fibrosis were estimated based on ELF response (defined as ≥0.5 unit reduction), and shifts in estimated fibrosis categories based on ELF (F3, ELF 9.8-11.3; F4, ELF >11.3) and LS by TE (F3, 9.6-12.5 kPa; F4, >12.5 kPa). Logistic regression was used to identify predictors of fibrosis improvement as defined by NITs. Results: 1,574 subjects with HCV cirrhosis (32% female, 39% BMI ≥30 kg/㎡, 7% CPT class B/C) were included in this study; median interval between SVR and registry enrollment was 38 weeks (IQR 27-60). At enrollment, median (IQR) ELF was 14.3 (9.5, 22.1); 586 (37%) and 247 (16%) patients had ELF scores consistent with F3 and F4 fibrosis, respectively. Median LS by TE was 9.9 kPa (9.2, 10.8); 761 (57%) and 227 (17%) patients had LS consistent with F3 and F4 fibrosis, respectively. As of May 2019, median duration of follow-up after registry enrollment was 123 weeks (IQR 96, 168). At week 144, 49% of those with baseline CPT class B/C had improved CPT class, while 98% of those with baseline CPT class A remained in CPT class A. During follow-up, changes in ELF and LS by TE suggested fibrosis improvement in an increasing proportion of patients with both F3 and F4 fibrosis at enrollment (Figure 1). ELF score improved by >0.5 units at week 144 in 27% and 47% of patients with baseline F3 and F4 fibrosis, respectively. Predictors of ELF improvement included higher ELF (P<0.001) and AST (P=0.049), and lower platelets (P=0.02) and BMI (P=0.10) at registry baseline. Conclusions: In patients with cirrhosis in whom HCV has been eradicated by SOF-based therapy, NITs suggest significant fibrosis improvement in 25-50% of patients within 3 years. Associations between reductions in these NITs and improvements in clinical outcomes require evaluation during longer-term follow-up.
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( Sooji Lee ),( Amanda W. Singer ),( Anu Osinusi ),( Diana M. Brainard ),( Anand P. Chokkalingam ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Chronic hepatitis C virus (HCV) infection has been associated with adverse cardiovascular and cerebrovascular outcomes. Viral eradication with direct-acting antiviral (DAA) therapy may decrease the risk of these events among HCV patients. We aimed to characterize the risk of cardiovascular and cerebrovascular events among HCV patients treated with DAA regimens compared to untreated patients in US claims data. Methods: 322,276 adults with chronic HCV were enrolled in the database between January 2006 and September 2015. We identified 8,342 HCV patients dispensed at least 12 weeks of DAA therapy (excluding boceprevir and telaprevir) and, for comparison, 76,423 untreated HCV patients who had follow-up time in the DAA era. Events were identified by diagnostic claims for acute and chronic ischemic heart disease, angina pectoris, cardiomyopathy, heart failure, subarachnoid hemorrhage, occlusion and stenosis of precerebral or cerebral arteries, cerebrovascular disease, cerebral atherosclerosis, intracerebral hemorrhage, and transient cerebral ischemia. Hazard ratios (HRs) estimating risk of incident cardiovascular and cerebrovascular events associated with completion of DAA therapy were calculated with adjustment for covariates using Cox proportional hazards methods. Results: HCV patients dispensed a full course of DAA therapy were more likely to be male, over 55 years-old, with baseline diagnoses of cirrhosis, diabetes, or hypertension, and on cardiovascular medications. After adjustment for covariates, there was a reduced risk of total cardiovascular and cerebrovascular events in patients completing DAA therapy compared to untreated patients (HR=0.86, 95% confidence interval [CI]: 0.74-0.99). Adjusted HRs were similar for cardiovascular disease (HR=0.90, 95%CI: 0.76-1.05) and cerebrovascular disease (HR=0.89, 95%CI: 0.74-1.08). Conclusions: In this real-world cohort, DAA therapy appeared to reduce the risk of cardiovascular and cerebrovascular events in HCV patients even within a short period following therapy. The benefits of curative DAA therapy in reducing extrahepatic complications of HCV may be even greater with longer follow-up.
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( Laura E. Telep Raj Reddy ),( Joonwoo Bahn ),( David Muramoto ),( Anu Osinusi ),( Diana M. Brainard ),( Anand P. Chokkalingam ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Hepatocellular carcinoma (HCC) is a common secondary liver disease of chronic hepatitis C virus (HCV) infection. The advent of interferon(IFN)-free, direct actinga ntiviral (DAA) regimens for HCV infection has enabled access to curative treatment for previously untreated patients. However, the effect of IFN-free DAA regimens on recurrence of HCC is poorly understood and hasn’t been studied in a large, population. This study aims to examine risk of HCC recurrence among HCV patients treated wit IFN-free DAA treatments versus regimens containing IFN. Methods: Using United States administrative claims data from 01/01/2006 to 09/30/2015, we identified 4,887 patients who were ever treated for HCC. HCV treatment regimens were stratified by presence or absence of concomitant IFN. Patients were observed from HCV treatment start until the first of: claim for HCC treatment, initiation of a different HCV regimen, enrollment end, or September 30, 2015. Hazard ratios (HRs) estimating risk of HCC recurrence associated with completion of IFN-free vs. IFN- containing therapy were calculated after adjusting for baseline confounders. Results: Patients completing IFN-free treatment (vs. IFN-containing) were more likely to be ≥ 55 years (82.7% vs. 45.1%) and have cirrhosis (95.7% vs. 88.2%), liver necrosis (34.8% vs. 9.8%), and portal hypertension (58.0% vs. 35.3%) at baseline. Median follow-up time was shorter in IFN-free regimens (182 daysvs. 349 days). After adjusting for age, sex, and significant baseline covariates, there was no difference in risk of HCC recurrence through the end of follow-up with IFN-free treatment regimens when compared to regimens containing IFN(adjusted HR: 0.97(95% CI: 0.49 - 1.92) Similar results were observed at 3, 6, and 12 months of follow-up. Conclusions: The results indicate that after adjusting for covariates, there is no difference in risk of HCC recurrence associated with IFN-free DAA-based HCV treatment regimens when compared to regimens containing IFN.
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