Comparing drug interaction frequencies of various hepatitis C treatment regimens among monoinfected patients

Prescription patterns of comedications associated with drug-drug interactions risk in HCV-infected patients undergoing direct-acting antiviral treatment: an analysis of an administrative claims database in Japan

INTRODUCTION

While direct-acting antivirals (DAA) are effective treatment for hepatitis C virus (HCV) patients, concerns about drug-drug interactions (DDIs) remain a significant challenge. Although there are several studies investigating the risk of DDIs associated with DAA therapy, there is limited research evaluating DDIs of DAA therapy in real-world settings in Japan. We investigated prescription patterns of comedication associated with DDIs risk in HCV patients receiving DAA therapy using a large Japanese database.

METHODS

This was a descriptive epidemiological study, using the Japanese administrative claims database provided by DeSC Healthcare, Inc. Patients who initiated sofosbuvir/velpatasvir (SOF/VEL) or glecaprevir/pibrentasvir (GLE/PIB) between April 2017 and August 2023 were identified from the data. The primary outcome was DDIs associated with comedications which were assessed based on both Japanese package inserts and the Liverpool HEP Drug Interaction Checker (Liverpool HEP checker).

RESULTS

Patients included in this study were 7,338, with 467 prescribed SOF/VEL and 6,871 prescribed GLE/PIB. The mean age of the patients was 69.9 years (SD = 13.1), with 50% being male. The median number of comedications was higher in the SOF/VEL group (14.0; IQR = 14.0) than in the GLE/PIB group (9.0; IQR = 12.0) and based on package insert and Liverpool HEP checker, the DDI risk was present in 59.3% (277) of the SOF/VEL group and 51.5% (3,542) of the GLE/PIB group. DDI risk involving two or more medications in combination with a DAA was 14.1% (66) in the SOF/VEL group and 24.0% (1,648) in the GLE/PIB group. In terms of DDI severity, in the SOF/VEL group there were no patients identified under the level "Contraindication (Red)" category, indicating medications that do not co-administered, in contrast with the 1.7% (115) in the GLE/PIB group who were identified as "contraindication (red)".

CONCLUSION

A considerable proportion of patients were prescribed medications with DDI risk during DAA treatment. A small but notable proportion of patients were on "Contraindication (Red)" medications. Consideration of the potential DDI risks associated with comedications by healthcare professionals is advised, referring not only to package inserts but also tools such as Liverpool HEP checker to guide safe prescribing when initiating DAA therapy for HCV patients.

Evaluation of Drug Interactions in Patients Treated with DAAs for Hepatitis C Therapy with Comorbidities and Cardiovascular Issues-A Delphi Consensus Project

Orally administered direct-acting antivirals (DAAs) have dramatically changed the possibility of curing HCV (hepatitis C virus) infection, with the two principal HCV regimens based on the combination of glecaprevir + pibrentasvir (GLE-PIB) and sofosbuvir + velpatasvir (SOF-VEL). A combination of drugs containing NS3/4A protease inhibitors, as well as the fact that almost all HCV patients can be treated at present, may expose patients to a higher rate of drug-drug interactions (DDIs). The hepatitis C treatment recommendations from the EASL (European Association for the Study of the Liver) state that, prior to starting treatment with a DAA, a detailed drug history should be taken; yet, the decision on managing the potential DDIs is not always clear. For this reason, a group of Italian cardiologists and hepatologists promoted a survey among colleagues to assess the controversial issues when treating patients with chronic hepatitis C taking concomitant cardiovascular drugs, aiming to reach a consensus on the best practice to apply when treating a patient with chronic hepatitis C who is taking concomitant drugs for cardiovascular diseases. Two consecutive questionnaires were proposed between June and July 2022 to a qualitative Expert Panel (EP) of 14 gastroenterologists, infectologists, hepatologists, and internists, with statistical analyses performed on 100% of the responses for both questionnaires. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. The interviewed experts consider DDIs a critical clinical problem to be evaluated in HCV patients. Therefore, dose changes, drug substitution, and discontinuation of concomitant cardiovascular drugs should be discouraged, even if planned for a relatively short period. Since oral DAAs have different DDIs profiles, hepatologists should prefer the antiviral DAA combination presenting the lowest instance of potential interactions.