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Intensive Pharmacy Care Improves Outcomes of Hepatitis C Treatment in a Vulnerable Patient Population at a Safety-Net Hospital

  • Ashley N. Tran
  • Rishabh Sachdev
  • Zachary P. Fricker
  • Michael Leber
  • Toni Zahorian
  • Bhavesh Shah
  • David P. Nunes
  • Michelle T. Long
Original Article

Abstract

Background

Treatment of hepatitis C virus (HCV) with direct-acting antiviral (DAA) regimens has resulted in high rates of sustained virologic response (SVR). Treatment of vulnerable populations may be improved by incorporating an on-site intensive specialty pharmacy (ON-ISP).

Aims

To describe outcomes of HCV treatment at a safety-net hospital and proportion of subjects achieving SVR for those using the ON-ISP compared to an off-site pharmacy (OFF-SP).

Methods

A retrospective cohort study of 219 subjects treated for HCV with DAA at Boston Medical Center was conducted. Subject characteristics, virologic response, and pharmacy services used were recorded. We used multivariable logistic regression to test the association between ON-ISP and SVR after adjusting for covariates.

Results

SVR occurred in 71% of subjects by intention-to-treat (73% among ON-ISP users vs 57% among OFF-SP users) and 95% completing treatment per-protocol (96% among ON-ISP users vs 87% among OFF-SP users). Adjustment for age, sex, ethnicity, insurance, fibrosis, prior treatment, and MELD revealed an increased likelihood of SVR among users of ON-ISP: OR 6.0 (95% CI 1.18–31.0). No significant difference in treatment delay or adverse events was seen among users of either pharmacy type.

Conclusions

HCV treatment with DAA was well tolerated, but the rate of SVR was low (71%) compared to trials. This was due to loss to follow-up, as the per-protocol rate of SVR was much higher (95%). Use of ON-ISP was associated with an increase in SVR and may be valuable for improving care for vulnerable populations.

Keywords

Hepatitis C virus Specialty pharmacy Sustained virologic response Safety-net hospital Direct-acting antiviral Clinical pharmacy 

Abbreviations

DAA

Direct-acting antiviral

HCV

Hepatitis C virus

OFF-SP

Off-site specialty pharmacy

ON-ISP

On-site intensive specialty pharmacy

SVR

Sustained virologic response

Notes

Funding

Dr. Long is supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases K23 DK113252 and the Boston University School of Medicine Department of Medicine Career Investment Award. Dr. Fricker is supported in part by the National Center for Advancing Translational Sciences and National Institutes of Health (BU-CTSI Grant Number 1UL1TR001430). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Compliance with ethical standards

Conflict of interest

There are no known conflicts of interest for any author.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Evans Department of Medicine, Boston University School of MedicineBoston Medical CenterBostonUSA
  2. 2.Section of Gastroenterology, Evans Department of Medicine, Boston University School of MedicineBoston Medical CenterBostonUSA
  3. 3.Clinical PharmacyBoston Medical CenterBostonUSA

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