Measures of adherence to HCV therapy in a specialty pharmacy setting and association with NON-SVR.
Kaurala SA, Veve M, Van Lare J, Mansour JS, Andrews M, Brown KA, and Davis S. Measures of adherence to HCV therapy in a specialty pharmacy setting and association with NON-SVR. Hepatology 2017; 66:594A.
Hepatology (Baltimore, Md.)
Background: Adherence to HCV antivirals is an important factor associated with SVR. Specialty pharmacies (SP) support adherence through benefits and prescription facilitation, and medication counseling for high cost or complex medication regimens. The goal of this study was to characterize the patient population with HCV managed by an institutional SP service and determine factors, including medication adherence, that are associated with NON‐SVR. METHODS: Retrospective cross‐sectional study with nested case‐control (1:3 matched) including adults receiving HCV therapy with a direct‐acting antiviral through SP Adherence was measured from electronic pharmacy data by two standard metrics: proportion of days covered (PDC) and medication possession ratio (MPR). MPR may be greater than 100% when accounting for early refill behavior. The outcome of interest was NON‐SVR. Additional data collected: patient, provider and disease characteristics. Variables associated with NON‐SVR were compared and included in a multivariable logistic regression model. RESULTS: 1,025 patients were included: 641 (63%) male, 407 (40%) black, median age 61, 882 (86%) HCV genotype 1. HCV treatment regimens were 99% sofosbuvir‐based: 746 (73%) ledipasvir‐sofosbuvir +/‐ ribavirin, 154 (15%) sofosbuvir with ribavirin, 11% other. 89 (9%) patients failed to achieve SVR. Among 344 pts in the case‐control study, PDC was not associated with SVR. A CART‐derived breakpoint of < 102.1% MPR was associated NON‐SVR (unadjOR 2.0, 95%CI 1. 2‐3.4). Variables associated with NON‐SVR are listed in Table 1. CONCLUSIONS: MPR > 102.1% was associated with improved SVR, and may reflect early refill behavior and fewer gaps in medication on hand. SP with HCV services should consider MPR and other modifiable factors to improve patient adherence and outcome.