ABSTRACT
In randomized controlled trials of patients with chronic HCV infection, elbasvir/grazoprevir (EBR/GZR) demonstrated high cure rates and a good safety profile. This study assessed the effectiveness and safety of EBR/GZR, with and without ribavirin, in a real-world HCV patient cohort. HEPA-C is a collaborative, monitored national registry of HCV patients directed by the Spanish Association for the Study of the Liver and the Networked Biomedical Research Centre for Hepatic and Digestive Diseases. Patients entered into HEPA-C between December 2016 and May 2017, and treated with EBR/GZR with at least end-of-treatment response data, were included. Demographic, clinical and virologic data were analysed, and adverse events (AEs) recorded. A total of 804 patients were included in the study. The majority were male (57.9%), with a mean age of 60 (range, 19-92) years. Genotype (GT) distribution was GT 1, 86.8% (1a, 14.3%; 1b, 72.5%); GT 4, 13.2% and 176 patients (21.9%) were cirrhotic. Overall, among 588 patients with available data, 570 (96.9%) achieved sustained virologic response at 12 weeks post-treatment (SVR12). SVR12 rates by genotype were GT 1a, 97.7%; GT 1b, 98.6%; and GT 4, 98.1%. No significant differences in SVR12 according to fibrosis stage were observed. Eighty patients experienced an AE, resulting in treatment discontinuation in three. In this large cohort of patients with chronic HCV managed in a real-world setting in Spain, EBR/GZR achieved high rates of SVR12, comparable to those observed in randomized controlled trials, with a similarly good safety profile.
Subject(s)
Antiviral Agents/therapeutic use , Benzofurans/therapeutic use , Hepatitis C, Chronic/drug therapy , Imidazoles/therapeutic use , Quinoxalines/therapeutic use , Sustained Virologic Response , Adult , Aged , Aged, 80 and over , Antiviral Agents/adverse effects , Benzofurans/adverse effects , Cohort Studies , Drug Combinations , Drug Therapy, Combination , Female , Genotype , Humans , Imidazoles/adverse effects , Male , Middle Aged , Prospective Studies , Quinoxalines/adverse effects , Registries , Retrospective Studies , Ribavirin/adverse effects , Ribavirin/therapeutic use , Spain , Treatment OutcomeABSTRACT
BACKGROUND: Transarterial chemoembolisation (TACE), having demonstrated survival benefits, is the treatmentof choice in intermediate-stage hepatocellular carcinoma, although there is great heterogeneity in its clinical application. MATERIAL AND METHODS: A survey was sent to the Madrid Regional hospitals to assess applicability, indications and treatment protocols. The assessment was made overall and according to the type of hospital (groups A vs. B and C). RESULTS: Seventeen out of 22 hospitals responded (8/8 group A, 9/ 14 group B-C). All do/indicate transarterial chemoembolisation, 13/17 at their own facilities. Eight of the 17 hospitals have multidisciplinary groups (5/8 A, 3/9 B-C). Nine hospitals perform > 20 procedures/year (7 group A), and 6 from group B-C request/perform < 10/year. It is performed on an "on-demand" basis in 12/17. In 5 hospitals, all the procedures use drug-eluting beads loaded with doxorubicin. The average number of procedures per patient is 2. The mean time from diagnosis of hepatocellular carcinoma to transarterial chemoembolisation is ≤ 2 months in 16 hospitals. In 11/17 hospitals, response is assessed by computed tomography. Radiological response is measured without specific criteria in 12/17 and the other five hospitals (4 group A) assessed using standardised criteria. CONCLUSION: Uniformity among the Madrid Regional hospitals was found in the indication and treatment regimen. The use of DEB-TACE has become the preferred form of TACE in clinical practice. The differentiating factors for the more specialised hospitals are a larger volume of procedures, decision-making by multidisciplinary committees and assessment of radiological response more likely to be standardised.
Subject(s)
Carcinoma, Hepatocellular/drug therapy , Chemoembolization, Therapeutic/trends , Hospitals/trends , Liver Neoplasms/drug therapy , Practice Patterns, Physicians'/trends , Carcinoma, Hepatocellular/mortality , Carcinoma, Hepatocellular/pathology , Guideline Adherence/trends , Health Care Surveys , Humans , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Neoplasm Staging , Practice Guidelines as Topic , Spain , Surveys and Questionnaires , Time Factors , Treatment OutcomeABSTRACT
Inflammatory cloacogenic polyps are infrequent lesions that usually arise in the anorectal zone. The most common clinical presentation is rectal bleeding. Two cases of rectal bleeding related to cloacogenic polyps with different endoscopic appearance are reported. Endoscopists should be familiar with this entity, which should be considered in the differential diagnosis with other polypoid lesions observed in colonoscopy.
Subject(s)
Intestinal Polyps/diagnosis , Rectal Diseases/diagnosis , Adult , Anal Canal , Colonoscopy , Diagnosis, Differential , Female , Gastrointestinal Hemorrhage/etiology , HumansABSTRACT
Los pólipos inflamatorios cloacogénicos son lesiones poco frecuentes, que suelen surgir en la zona anorrectal. La presentación clínica más frecuente es en forma de sangrado rectal. Se presentan 2 casos de pólipos cloacogénicos con distinto aspecto endoscópico y clínica de rectorragia. El endoscopista debe tener en cuenta la existencia de esta entidad y considerarla en el diagnóstico diferencial con otras lesiones polipoideas que se pueden observar en la colonoscopia
Inflammatory cloacogenic polyps are infrequent lesions that usually arise in the anorectal zone. The most common clinical presentation is rectal bleeding. Two cases of rectal bleeding related to cloacogenic polyps with different endoscopic appearance are reported. Endoscopists should be familiar with this entity, which should be considered in the differential diagnosis with other polypoid lesions observed in colonoscopy
