February 24, 2020
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DDIs affect around 40% of HCV patients taking DAAs

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Benjamin Maasoumy, MD 
Benjamin Maasoumy
Benjamin Schulte 
Benjamin Schulte

Drug-drug interactions, or DDIs, affect about 40% of patients with hepatitis C virus being treated with direct-acting antivirals, or DAAs, according to a study published in Open Forum Infectious Diseases. Researchers said lower DDI potential among modern DAA regimens is counteracted by changing patient characteristics.

“Despite the large improvements in the field of HCV therapy, DDIs are still relevant,” Benjamin Maasoumy, MD, clinical physician in the department of gastroenterology, hepatology and endocrinology at Hannover Medical School and the German Center for Infection Research in Hannover, Germany, and Benjamin Schulte, clinical pharmacist at Hannover Medical School and the German Center for Infection Research, told Healio. “We recommend a brief consideration of all concomitant medications regarding possible interactions before initiation of HCV treatment.”

Maasoumy, Schulte and colleagues assessed 668 consecutive HCV patients for their outpatient medication and DDIs with DAAs from January 2014 to July 2018. They studied three different time periods based on market approvals of important DAAs — January 2014 to November 2014 (period A), November 2014 to August 2016 (period B) and August 2016 to July 2018 (period C).

The frequency of patients with real-world DDIs was highest in period B at 49.6%, with frequencies of 37.1% and 38.8% for periods A and C, respectively. Although DAAs in period C showed a lower DDI risk profile, real-world DDIs were still comparable to period A due to changing HCV patient characteristics, the researchers said. For example, the percentage of patients with HCV aged 75 years or older was 3.1%, 9.8% and 5.6% in periods A, B and C respectively. Additionally, the percentage of polypharmacy patients with HCV using eight or more drugs in their outpatient medication was 11.1%, 15.2% and 17.2% for periods A, B and C, respectively.

Maasoumy and Schulte noted that changes to eligibility criteria have provided treatment opportunities for patients at high risk for DDI.

“The most important fact regarding this issue is that developing patient characteristics are only taken into account when looking at the real-world data,” Massoumy and Schulte said. “Eligibility and efficacy have undergone major changes throughout the years, making it now possible to also treat populations which have a high risk for DDI like the elderly, polypharmaceutical patients and transplanted patients under immunosuppression.”

They emphasized that increasing the efficiency of medical data could be a major benefit to future DDI research.

“The retrospective analysis and evaluation of the medication data is time consuming and complex,” Maasoumy and Schulte said. “Digital data and automated generation of medication data would lead to enormous benefits regarding an efficient workflow.” – by Eamon Dreisbach

Disclosure: Maasoumy reports receiving speaker and/or consulting fees from Abbott, Abbvie Molecular, Astellas, Bristol Myers Squibb, Falk, Fujirebio, Intercept, Janssen-Cilag, Merck (MSD), Norgine and Roche and receiving research support from Abbott Molecular and Roche. Schulte reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.