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Intensive Pharmacy Care Improves Outcomes of Hepatitis C Treatment in a Vulnerable Patient Population at a Safety-Net Hospital

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Abstract

Background

Treatment of hepatitis C virus (HCV) with direct-acting antiviral (DAA) regimens has resulted in high rates of sustained virologic response (SVR). Treatment of vulnerable populations may be improved by incorporating an on-site intensive specialty pharmacy (ON-ISP).

Aims

To describe outcomes of HCV treatment at a safety-net hospital and proportion of subjects achieving SVR for those using the ON-ISP compared to an off-site pharmacy (OFF-SP).

Methods

A retrospective cohort study of 219 subjects treated for HCV with DAA at Boston Medical Center was conducted. Subject characteristics, virologic response, and pharmacy services used were recorded. We used multivariable logistic regression to test the association between ON-ISP and SVR after adjusting for covariates.

Results

SVR occurred in 71% of subjects by intention-to-treat (73% among ON-ISP users vs 57% among OFF-SP users) and 95% completing treatment per-protocol (96% among ON-ISP users vs 87% among OFF-SP users). Adjustment for age, sex, ethnicity, insurance, fibrosis, prior treatment, and MELD revealed an increased likelihood of SVR among users of ON-ISP: OR 6.0 (95% CI 1.18–31.0). No significant difference in treatment delay or adverse events was seen among users of either pharmacy type.

Conclusions

HCV treatment with DAA was well tolerated, but the rate of SVR was low (71%) compared to trials. This was due to loss to follow-up, as the per-protocol rate of SVR was much higher (95%). Use of ON-ISP was associated with an increase in SVR and may be valuable for improving care for vulnerable populations.

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Abbreviations

DAA:

Direct-acting antiviral

HCV:

Hepatitis C virus

OFF-SP:

Off-site specialty pharmacy

ON-ISP:

On-site intensive specialty pharmacy

SVR:

Sustained virologic response

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Funding

Dr. Long is supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases K23 DK113252 and the Boston University School of Medicine Department of Medicine Career Investment Award. Dr. Fricker is supported in part by the National Center for Advancing Translational Sciences and National Institutes of Health (BU-CTSI Grant Number 1UL1TR001430). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Author notes

  1. Ashley N. Tran and Rishabh Sachdev are intended as co-first authors.

Authors and Affiliations

  1. Evans Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA

    Ashley N. Tran & Rishabh Sachdev

  2. Section of Gastroenterology, Evans Department of Medicine, Boston University School of Medicine, Boston Medical Center, 85 East Concord Street 7th Floor, Boston, MA, 02118, USA

    Zachary P. Fricker, David P. Nunes & Michelle T. Long

  3. Clinical Pharmacy, Boston Medical Center, Boston, MA, USA

    Michael Leber, Toni Zahorian & Bhavesh Shah

Authors
  1. Ashley N. Tran
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  2. Rishabh Sachdev
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Correspondence to Michelle T. Long.

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Tran, A.N., Sachdev, R., Fricker, Z.P. et al. Intensive Pharmacy Care Improves Outcomes of Hepatitis C Treatment in a Vulnerable Patient Population at a Safety-Net Hospital. Dig Dis Sci 63, 3241–3249 (2018). https://doi.org/10.1007/s10620-018-5231-0

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  • DOI: https://doi.org/10.1007/s10620-018-5231-0

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