Background In the era of direct antiviral agents (DAA) for hepatitis C virus (HCV) therapy, optimising treatment with multidisciplinary strategies improves compliance and efficacy.
Purpose To evaluate the pharmacist’s role in HCV therapeutic management, to minimise compliance issues, and drug–drug interactions (DDI) and adverse events management.
Material and methods Prospective analysis of HCV patients treated with DAA regimens at a peripheral hospital (12 February 2015–15 June 2016) that enrolled in monthly outpatient pharmaceutical consultations. Baseline and on-treatment parameters were reassessed per consultation: need for therapeutic changes, DDI behavioural awareness, compliance and adverse events (AE).
Results Throughout 544 consultations, 142 patients (11 HIV/HCV) underwent 145 DAA regimens (3 DAA failures retreated): LDV/SOF (116 patients, RBV-19 patients), OBV+PTP/r+DSV+RBV (1), SOF/DAC (3 patients), SOF/RBV (15 patients), SOF/RBV/PegIFN (10 patients). 47 active interventions occurred at baseline consultations (32%): 21.4% (31 patients) had concomitant drugs that were reassessed. (A) Drugs with changes needed: PPI-13.1% (19 patients; intake hour change-17 patients; dose reduction alert-2 patients); statins-2.1% (3 in 11 patients were stopped at the time); antidiabetic agents-2% (3 patients; intake hour change-2 patients; awareness to stoppage-1 patient); venotropic drugs-1.4% (stoppage-2 patients); loperamide-1.4%( DDI stoppage-2 patients); antihistamines-2% (DDI stoppage-1 diphenydramine); vitamins-2% (stoppage-3 patients); acetylcystein-0.7% (stoppage-1 patient); tenofovir DDI alert-0.7% (1 HIV/HCV); beta-blocker-0.7% (dose reduction-1 patient). Herbal tea stoppage-7.5% (11 patients).
(B) No changes needed: neuropsychiatric drugs-23.4% (34 patients); antihypertensive drugs-20% (29 patients); diuretics-15.6% (10 patients); NSAID’s-6.9% (10 patients); analgesics-6.2% (9 patients); methadone-6.2% (9 patients); antiagregation therapy-6.5% (5 patients); and other drugs in 16.9% (13 patients). Awareness to keep off statins/fibrates-10 patients. On treatment: compliance assessment: pill intake mistake-17.2% (25 patients: forgot DAA once-15 patients; overdosage with 2 DAA-4 patients; RBV intake error-4 patients), 80% during first 2 months. New drugs/behaviours occurred in 20% (30 patients: St John’s Wort stoppage-1 patient; PPI intake hour change-2 patients). 3 DAA failures retreated were not on PPI, had no pill error; one took St John’s Wort. Available SVR12 tended to be lower in those with errors detected (69% to 88.4%). 12.4% (18 patients) telephoned mostly to report AE. AE-68.3% (99 patients); 478 non-severe; 1 severe (1%, drug related encephalopathy): most common were headache (27.6%) and fatigue (20%), 42.7% during 1st month. 3 patients were admitted to hospital, non-drug related. 2 patients stopped DAA (1 patient-encephalopathy; 1 patient-hospital admission).
Conclusion Pharmaceutical interventions at our centre helped optimise HCV treatment in one-third of cases at the start but also throughout the treatment process, validating the pharmacist role within the multidisciplinary management of HCV.
References and/or acknowledgements 1. European Association for the study of the liver. EASL recommendations on treatment of hepatitis C 2014.
No conflict of interest
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