Comorbidities and the use of comedications among patients with chronic hepatitis C in Korea: A nationwide cross-sectional study

Abstract

Background/aims: Chronic hepatitis C (CHC) is the second leading cause of liver-related mortality and is more prevalent in the elderly population in Korea. Decisions to initiate treatment and selection of proper antiviral agents may be challenging among elderly patients due to relevant comorbidities, comedications, and drug-drug interaction (DDI). It may be helpful to understand the current demographic status and comorbidities of CHC patients in the country.

Methods: Patients aged ≥ 18 years and diagnosed with CHC (KCD-7 code B18.2) were extracted from the Korean Health Insurance Review & Assessment Service database in 2018. Data on comorbidities and comedications were assessed and potential DDIs were analyzed.

Results: A total of 50,476 patients with CHC, with a mean age of 60.3 years and 46.7% male patients were identified. The proportion of patients with cirrhosis, hepatocellular carcinoma, and liver transplantation was 6.0%, 4.1%, and 0.3%, respectively and 37.2% of patients were more than 65 years of age. The three most common comorbidities were diseases of the digestive system (83.7%), respiratory system (58.2%), and musculoskeletal system and connective tissue (57.6%). The three most common comedications were analgesics (91.6%), gastrointestinal agents (85%), and antibacterials (80.3%). Lipid-lowering agents and anticonvulsants were prescribed in 28.5% and 14.8% of patients. Rate of potential DDI for contraindication was 2.2%, 13.1%, and 15.6% with sofosbuvir/velpatasvir, ledipasvir/sofosbuvir, and glecaprevir/pibrentasvir.

Conclusion: With the increasing age of patients with CHC, comorbidity, comedication, and potential DDI should be considered when choosing antivirals in Korea. Sofosbuvir-based regimens showed favorable DDI profiles among Korean patients.

Keywords: Antiviral agents/therapeutic use; Comorbidity; Drug interactions; Hepatitis C; Polypharmacy.

Figure 1

Distribution of chronic hepatitis C patients in Korea with ≥ 1 comorbidities based on age and disease categories. ^a)Include the following disease categories: category V (mental and behavioral disorders); category VI (diseases of the nervous system); category II (neoplasms); category VIII (diseases of the ear and mastoid processes); and category III (diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism).

Figure 2

Distribution of chronic hepatitis C patients in Korea with ≥ 1 comedications based on age and comedication categories. ^a)Include comedications of anaesthetics, muscle relaxants; antifungals; anticonvulsants; bisphosphonates; hepatitis drugs; parkinsonism agents; antipsychotics, neuroleptics; antivirals; antiprotozoals; cytotoxics; contraceptives and hormonal replacements; immunosuppressants; antimigraine agents; oxytocics; human immunodeficiency virus drugs; and anthelmintics.

Figure 3

The proportion of potential drug-drug interaction (DDI) types with direct-acting antiviral (DAA) regimen by health conditions in hepatitis C virus (HCV) infected patients. (A) Proportion of DDIs reported among all HCV diagnosed patients. (B) Proportion of DDIs reported among HCV diagnosed patients with cirrhosis. (C) Proportion of DDIs reported among all HCV diagnosed patients in the DAA exposed group. (D) Proportion of DDIs reported among all HCV diagnosed patients in the DAA unexposed group. DDI were categorized as ‘Contraindication’ from reference of Liverpool University and Pecking University. LDV, ledipasvir; SOF, sofosbuvir; VEL, velpatasvir; GLE, glecaprevir; PIB, pibrentasvir. ^a)p values indicated for each potential DDIs (contraindication; potential interaction; no interaction expected) across each DAA regimen (LDV/SOF vs. SOF/VEL vs. GLE/PIB). ^b)p values indicated for potential DDIs (contraindication; potential interaction; no interaction expected) across each DAA regimen (SOF/VEL vs. GLE/PIB).