CP-210 The added role of pharmaceutical intervention on hepatitis C virus direct antiviral agent treatment: a single centre observational prospective cohort analysis. (25th February 2017)

• Record Type: Journal Article
• Authors: Gaspar, A; Vieira, C; Barradas, V; Dimas, F
• Is Part Of: European journal of hospital pharmacy. Volume 24(2017)Supplement 1
• Page Start: A94
• Page End: A94
• Publication Date: 2017-02-25
• Subjects: Pharmacy -- Periodicals; Hospital pharmacies -- Periodicals; 615.1
• DOI: 10.1136/ejhpharm-2017-000640.208
• Languages: English
• ISSNs: 2047-9956

Abstract

Abstract : Background: In the era of direct antiviral agents (DAA) for hepatitis C virus (HCV) therapy, optimising treatment with multidisciplinary strategies improves compliance and efficacy. Purpose: To evaluate the pharmacist's role in HCV therapeutic management, to minimise compliance issues, and drug–drug interactions (DDI) and adverse events management. Material and methods: Prospective analysis of HCV patients treated with DAA regimens at a peripheral hospital (12 February 2015–15 June 2016) that enrolled in monthly outpatient pharmaceutical consultations. Baseline and on-treatment parameters were reassessed per consultation: need for therapeutic changes, DDI behavioural awareness, compliance and adverse events (AE). Results: Throughout 544 consultations, 142 patients (11 HIV/HCV) underwent 145 DAA regimens (3 DAA failures retreated): LDV/SOF (116 patients, RBV-19 patients), OBV+PTP/r+DSV+RBV (1), SOF/DAC (3 patients), SOF/RBV (15 patients), SOF/RBV/PegIFN (10 patients). 47 active interventions occurred at baseline consultations (32%): 21.4% (31 patients) had concomitant drugs that were reassessed. (A) Drugs with changes needed: PPI-13.1% (19 patients; intake hour change-17 patients; dose reduction alert-2 patients); statins-2.1% (3 in 11 patients were stopped at the time); antidiabetic agents-2% (3 patients; intake hour change-2 patients; awareness to stoppage-1 patient); venotropic drugs-1.4% (stoppage-2 patients); loperamide-1.4%( DDI stoppage-2 patients); antihistamines-2% (DDI stoppage-1 diphenydramine); vitamins-2% (stoppage-3 patients); acetylcystein-0.7% (stoppage- 1 patient); tenofovir DDI alert-0.7% (1 HIV/HCV); beta-blocker-0.7% (dose reduction-1 patient). Herbal tea stoppage-7.5% (11 patients). (B) No changes needed: neuropsychiatric drugs-23.4% (34 patients); antihypertensive drugs-20% (29 patients); diuretics-15.6% (10 patients); NSAID's-6.9% (10 patients); analgesics-6.2% (9 patients); methadone-6.2% (9 patients); antiagregation therapy-6.5% (5 patients); and other drugs in 16.9% (13 patients). Awareness to keep off statins/fibrates-10 patients. On treatment: compliance assessment: pill intake mistake-17.2% (25 patients: forgot DAA once-15 patients; overdosage with 2 DAA-4 patients; RBV intake error-4 patients), 80% during first 2 months. New drugs/behaviours occurred in 20% (30 patients: St John's Wort stoppage-1 patient; PPI intake hour change-2 patients). 3 DAA failures retreated were not on PPI, had no pill error; one took St John's Wort. Available SVR12 tended to be lower in those with errors detected (69% to 88.4%). 12.4% (18 patients) telephoned mostly to report AE. AE-68.3% (99 patients); 478 non-severe; 1 severe (1%, drug related encephalopathy): most common were headache (27.6%) and fatigue (20%), 42.7% during 1st month. 3 patients were admitted to hospital, non-drug related. 2 patients stopped DAA (1 patient-encephalopathy; 1 patient-hospital admission). Conclusion: Pharmaceutical interventions at our centre helped optimise HCV treatment in one-third of cases at the start but also throughout the treatment process, validating the pharmacist role within the multidisciplinary management of HCV. References and/or acknowledgements: 1. European Association for the study of the liver. EASL recommendations on treatment of hepatitis C 2014. No conflict of interest