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. 2017 Mar 7;23(9):1618-1626.
doi: 10.3748/wjg.v23.i9.1618.

Optimizing hepatitis C virus treatment through pharmacist interventions: Identification and management of drug-drug interactions

Jacob A Langness  1 , Matthew Nguyen  1 , Amanda Wieland  1 , Gregory T Everson  1 , Jennifer J Kiser  1
Affiliations

Optimizing hepatitis C virus treatment through pharmacist interventions: Identification and management of drug-drug interactions

Jacob A Langness et al. World J Gastroenterol. .

Abstract

Aim: To quantify drug-drug-interactions (DDIs) encountered in patients prescribed hepatitis C virus (HCV) treatment, the interventions made, and the time spent in this process.

Methods: As standard of care, a clinical pharmacist screened for DDIs in patients prescribed direct acting antiviral (DAA) HCV treatment between November 2013 and July 2015 at the University of Colorado Hepatology Clinic. HCV regimens prescribed included ledipasvir/sofosbuvir (LDV/SOF), paritaprevir/ritonavir/ombitasvir/dasabuvir (OBV/PTV/r + DSV), simeprevir/sofosbuvir (SIM/SOF), and sofosbuvir/ribavirin (SOF/RBV). This retrospective analysis reviewed the work completed by the clinical pharmacist in order to measure the aims identified for the study. The number and type of DDIs identified were summarized with descriptive statistics.

Results: Six hundred and sixty four patients (83.4% Caucasian, 57% male, average 56.7 years old) were identified; 369 for LDV/SOF, 48 for OBV/PTV/r + DSV, 114 for SIM/SOF, and 133 for SOF/RBV. Fifty-one point five per cent of patients were cirrhotic. Overall, 5217 medications were reviewed (7.86 medications per patient) and 781 interactions identified (1.18 interactions per patient). The number of interactions were fewest for SOF/RBV (0.17 interactions per patient) and highest for OBV/PTV/r + DSV (2.48 interactions per patient). LDV/SOF and SIM/SOF had similar number of interactions (1.28 and 1.48 interactions per patient, respectively). Gastric acid modifiers and vitamin/herbal supplements commonly caused interactions with LDV/SOF. Hypertensive agents, analgesics, and psychiatric medications frequently caused interactions with OBV/PTV/r + DSV and SIM/SOF. To manage these interactions, the pharmacists most often recommended discontinuing the medication (28.9%), increasing monitoring for toxicities (24.1%), or separating administration times (18.2%). The pharmacist chart review for each patient usually took approximately 30 min, with additional time for more complex patients.

Conclusion: DDIs are common with HCV medications and management can require medication adjustments and increased monitoring. An interdisciplinary team including a clinical pharmacist can optimize patient care.

Keywords: Clinical pharmacist; Drug-drug interaction; Hepatitis C virus treatment.

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Conflict of interest statement

Conflict-of-interest statement: Langness JA and Nguyen M have nothing to disclose. Wieland A receives grant funding from Janssen. Everson GT receives grant funding from Merck, Abbvie, Gilead, BMS, and Janssen and is on Ad Boards for Merck, Abbvie, Gilead, BMS, and Janssen. Everson GT has ownership and management of HepQuant LLC. Kiser JJ receives research support paid to her institution from ViiV Healthcare and free study medication for an NIH trial from Gilead Sciences.

Figures

Figure 1
Figure 1
Recommendations for management of drug-drug interactions (n = 664). Other recommendations: continue, alternative medication and alter administration, decrease dose and increase monitoring, decrease dose and separate administration, and increase dose.
See this image and copyright information in PMC

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