Pharmacist-driven HCV treatment model yields high SVR rates
Clinical pharmacist-delivered hepatitis C virus therapy yields high rates of SVR, according to findings published in Open Forum Infectious Diseases.
“In order to meet national hepatitis C elimination goals, expansions of the care team and innovations in care delivery are needed,” David Koren, PharmD, BCPS, AAHIVP, clinical pharmacy specialist in infectious diseases at Temple University Hospital, told Infectious Disease News. “Through the usage of collaborative practice agreements, clinical pharmacists are effective to drive and deliver hepatitis C treatment.”
Koren and colleagues explained that previous research has demonstrated the success of including mid-level providers and nonspecialist primary care providers in the HCV treatment workforce, but evidence demonstrating the effectiveness of a clinical pharmacist-driven HCV delivery model in an open medical system has not yet been documented.
They conducted a multicenter retrospective cohort study that included 1,253 patients who initiated direct-acting antivirals (DAAs) between Jan. 1, 2014, and March 12, 2018, at four participating institutions: Creighton University, Temple University Health System, University of Illinois Hospital and Health Sciences System and Vanderbilt University Medical Center.
Of the patients who initiated treatment, 95 were lost to follow up and 24 discontinued therapy. The primary outcome was SVR, analyzed for patients who initiated treatment (the intent-to-treat population) and those who completed treatment (the per-protocol population).
The mean age of patients was 57.4 years, 63.9% were male, 53.7% were black, 40.3% were cirrhotic, 88.4% had HCV genotype 1 and 81.6% were treatment-naive, the researchers reported.
According to the study, 95.1% of patients in the per-protocol population demonstrated SVR, whereas 86.1% of the intent-to-treat population demonstrated SVR. Patients who missed one or more treatment doses had an SVR of 74.9%, whereas those with full adherence had an SVR of 90% (P < .0001), Koren and colleagues noted.
They underscored that this was the first study to demonstrate the efficacy of using such a model across multiple institutions that serve a large and diverse patient population.
“The multi-site nature of the study as well as inclusion of complex patient groups demonstrate reproducibility and validate that clinical pharmacists can provide successful hepatitis C treatment to a variety of patients when delivered as part of an interdisciplinary, collaborative team,” Koren said. – by Marley Ghizzone
Disclosures: Koren reports receiving research funding from Gilead Sciences and serving on an advisory board for Gilead Sciences and ViiV Healthcare. Please see the study for all other authors relevant financial disclosures.