Prospective Data on People Who Use Drugs in Switzerland: The SAMMSU Cohort

Author: Moriggia A, Bregenzer A, Bruggmann P, Castro E, Rothen E, Rougemont M, Staehelin C, Thurnheer C, Schmid P, Scheidegger C

Theme: Clinical Research Year: 2016


Moriggia A1-2, Bregenzer A3, Bruggmann P4, Castro E5, Rothen E6, Rougemont M7, Staehelin C8-9, Thurnheer C8-9, Schmid P10, Scheidegger C11

1Epatocentro Ticino SA, Lugano; 2Ingrado Servizi per Le Dipendenze, Lugano; 3Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Aarau; 4Arud Centres for Addiction Medicine, Zurich; 5Policlinique d’addictologie, Service de Psychiatrie Communautaire, CHUV, Lausanne; 6Spitalzentrum Centre hospitalier Biel-Bienne; 7Dpt. De Médecine Communautaire, de Premier Recours des Urgences, Hôpitaux Universitaire de Genève; 8University Clinic for Infectious Diseases, Inselspital, University Hospital of Bern; 9Kontrollierte Drogenabgabe Bern (KODA); 10Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen; 11Centre for Addiction Medicine Basel.

Background: The aim of the Swiss Association for the Medical Management in Substance Users (SAMMSU) is to improve medical management of People who use drugs (PWUD) in Switzerland. In 2013, a nationwide prospective cohort study of PWUD in Switzerland was established, with 9 participating centres (Aarau, Basel, Bern, Biel-Bienne, Geneve, Lausanne, St. Gallen, Zürich, Ticino).

Methods: The SAMMSU cohort is an ongoing, prospective, open cohort of PWUD. Data collection started in late 2014. Inclusion criteria are: to be or have been on opioid substitution and to be at least 18 years old. Data are collected annually with a wide list of key parameters including demographical and socio-economical variables, drug and alcohol use, psychiatric and somatic comorbidities and therapies. Special attention is given to HCV management and treatment.

Results: As of April 2016, 325 subjects were enrolled in the cohort. Mean age was 43 years, 80% were males. Opioid substitution was in 59% methadone, 16% buprenorphine, 10% morphine, 6% heroin and 5% methadone+heroin. HCV-Ab prevalence (confirmatory testing) was 64% (204/318). HCV-RNA was tested in 166 HCV-Ab positive subjects (81%). Ninety-eight (59%) were HCV-RNA positive at most recent test. For 87 (89%) HCV genotype was available: 46% GT1, 2% GT2, 34% GT3, 17% GT4. Sixty-two subjects were HIV positive (19%), of whom 59 (97%) received HIV treatment and 31 (50%) were HIV/HCV coinfected with detectable HCV-RNA. Of 217 subjects with liver fibrosis assessment, 64% had stage F0/F1, 8% F2, 10% F3 and 18% F4. Of 56 HCV treatments, 38 (68%) resulted in a sustained virological response (SVR), while in 6 treatments (11%) adherence issues were reported.

Conclusion: The SAMMSU cohort is a developing prospective cohort of PWUD in Switzerland. It will allow a more accurate description of a large population (potentially 2900 subjects) with a special focus on disease progression over time.

Sponsoring: SAMMSU is financed by Infodrog (on behalf of Swiss Federal Office of Public Health), Pharma industries (BMS, Abbvie, Gilead, Merck, Roche), SSAM (Swiss Society for Addiction Medicine), SEVHep (Swiss Experts in Viral Hepatitis), Inselspital Bern, Kantonspital St. Gallen, Kantonspital Aarau, Arud Zentren für Suchtmedizin, ZfS Zentrum für Suchtmedizin Basel, UniversitätsSpital Zürich.

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