Evaluating utilization and management of comedications with potential for drug-drug interactions among patients with chronic hepatitis C initiating treatment with sofosbuvir/velpatasvir or glecaprevir/pibrentasvir

Document Type

Conference Proceeding

Publication Date

6-1-2023

Publication Title

J Hepatol

Abstract

Background and aims: Direct-acting antiviral (DAA) agents for treatment of chronic hepatitis C (HCV) include glecaprevir/pibrentasvir (GLE/PIB), a protease inhibitor with known drug-drug interaction (DDI) effects, and sofosbuvir/velpatasvir (SOF/VEL), a protease inhibitor-free regimen with a more favorable DDI profile. This analysis compared rates and management of comedications with DDI risk (DDI comedications) among patients initiating DAA treatment with SOF/VEL or GLE/PIB. Method: Adults initiating SOF/VEL or GLE/PIB from July 2016–April 2020 were identified from US administrative claims data in the Optum Research Database. The index date was the first claim for SOF/VEL or GLE/PIB. Continuous enrollment 12 months before (baseline) and 6 months after the index date was required. Patients with baseline liver disease, HCV treatment, or HIV were excluded. Demographics and DDI comedication use were measured. All DDI comedications associated with GLE/PIB and SOF/VEL and DDI comedication severity, defined from more to less severe as red, amber, or yellow, were from the Liverpool HEP Drug Interactions Database. DDI comedication discontinuation, dose decrease, and change to medication with no DDI risk during DAA treatment were measured in the subset of patients with prevalent DDI comedications 90 days prior to index. Results: Among 4,528 patients meeting study criteria, 66.6% of GLE/PIB initiators and 43.7% of SOF/VEL initiators had any baseline DDI comedication use (p < 0.01). Compared with SOF/VEL initiators, GLE/PIB initiators had higher baseline rates of red (21.4% vs 2.3%), amber (51.9% vs 41.6%), and yellow (31.4% vs 2.8%, all p < 0.01) DDI comedications. DDI comedication use decreased during DAA treatment but remained higher in GLE/PIB initiators vs SOF/VEL initiators (41.5% vs 28.9%, p <0.01). Overall, 979 GLE/PIB and 658 SOF/VEL initiators used prevalent DDI comedications in the 90 days pre-index. Of these, GLE/PIB vs SOF/VEL initiators had similar mean age (61.6 vs 61.8 years), proportions of female (42.2% vs 38.8%) and commercially insured (32.0% vs 29.5%) patients; baseline compensated cirrhosis was lower among GLE/PIB vs SOF/VEL initiators (5.8% vs 9.6%, p < 0.01). A higher proportion of GLE/PIB vs SOF/VEL initiators discontinued at least 1 DDI comedication before initiating DAA treatment (52.2% vs 38.0%, p < 0.01). During DAA treatment, GLE/PIB vs SOF/VEL initiators had higher rates of dose decrease (10.8% vs 6.8%, p = 0.026) and change to medication with no DDI risk (3.5% vs 1.1%, p = 0.014). Conclusion: Use of DDI comedications was identified among a substantial proportion of patients, with higher rates of DDI comedication use and actions taken to manage DDI comedication use in GLE/PIB vs SOF/VEL initiators. Additional research is needed to assess real-world consequences of potential DDIs. [Figure presented]

PubMed ID

Not assigned.

Volume

78

First Page

1208

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