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Pharmacist-led pre-treatment assessment, management and outcomes in a Hepatitis C treatment patient cohort

  • Miriam CoghlanEmail author
  • Aisling O’Leary
  • Gail Melanophy
  • Colm Bergin
  • Suzanne Norris
Research Article
  • 4 Downloads

Abstract

Background Medication reconciliation and drug–drug interaction management represent important patient safety processes completed by pharmacists as part of Hepatitis C patient care. Objectives To describe the pharmacist-led interventions of medication reconciliation and drug–drug interaction assessment, grading and management in a real-world Hepatitis C treatment cohort and to assesses the impact on patient outcomes. Setting Two Hepatitis C hospital outpatient clinics at St. James’s Hospital, Dublin. Method Patients treated with Hepatitis C direct acting anti-viral agents between December 2014 and February 2017 were included in this retrospective cohort study. The study employed a standardised medication reconciliation proforma and drug–drug interaction reference list. Main outcome measures Analyse medication variances identified during pharmacist-led medication reconciliation. Assess the prevalence, type and severity of drug–drug interactions between direct acting anti-virals and co-medications. Assess the rate of prescriber acceptance of the pharmacist-developed drug–drug interaction management strategies. Results Among the 300 patients in this study, medication reconciliation identified 1543 co-medications, with 71% of patients prescribed co-medications which were subject to a potential drug–drug interaction. Drug–drug interaction assessments assigned a rating of severe to 68 interaction episodes. At least one co-medication was stopped during treatment in 25% of patients to facilitate drug–drug interaction management. Pharmacist proposed management recommendations were accepted by prescribers in 96.9% of cases. The sustained virological response rate among the cohort was 92.7%. Conclusions In this Hepatitis C pre-treatment pharmacist assessment analysis, a significant number of medication reconciliation variances and clinically significant drug–drug interactions were identified which present unique and important patient safety risks. Pharmacist-led management strategies aided the achievement of optimum treatment response while promoting patient safety and antiviral stewardship.

Notes

Acknowledgements

The authors would like to acknowledge the co-operation of patients and staff at the Hepatology Department and the Department of GU Medicine & Infectious Diseases, St. James’s Hospital in the completion of this research project.

Funding

None.

Conflicts of interest

MC has received research funding from the Irish Hepatitis C Research and Outcomes Network. CB has served as an advisory board member for AbbVie, Janssen, Gilead and BMS and has received research funding from Gilead and AbbVie. SN has served as a speaker, a consultant or advisory board member for AbbVie, Gilead, BMS, Janssen and Roche Pharmaceuticals and has received research funding from AbbVie.

Supplementary material

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Supplementary material 1 (DOCX 31 kb)

References

  1. 1.
    Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet (London, England). 2012;380:2095–28.CrossRefGoogle Scholar
  2. 2.
    van der Meer AJ, Veldt BJ, Feld JJ, Wedemeyer H, Dufour JF, Lammert F, et al. Association between sustained virological response and all-cause mortality among patients with chronic Hepatitis C and advanced hepatic fibrosis. JAMA. 2012;308(24):2584–93.CrossRefGoogle Scholar
  3. 3.
    Veldt BJ, Heathcote EJ, Wedemeyer H, Reichen J, Hofmann WP, Zeuzem S, et al. Sustained virologic response and clinical outcomes in patients with chronic Hepatitis C and advanced fibrosis. Ann Intern Med. 2007;147(10):677–84.CrossRefGoogle Scholar
  4. 4.
    Soriano V, Labarga P, de Mendoza C, Fernández-Montero JV, Esposito I, Benítez-Gutiérrez L, et al. New Hepatitis C therapies for special patient populations. Expert Opin Pharmacother. 2016;17(2):217–29.CrossRefGoogle Scholar
  5. 5.
    AASLD-IDSA. Recommendations for testing, managing, and treating Hepatitis C. 2017. Available from: http://www.hcvguidelines.org.
  6. 6.
    Gray E, O’Leary A, Bergin C, Cannon M, Courtney G, Crosbie O, et al. Effectiveness of interferon-free therapy for the treatment of HCV-patients with compensated cirrhosis treated through the Irish early access program. Expert Rev Gastroenterol Hepatol. 2017;11(6):593–601.CrossRefGoogle Scholar
  7. 7.
    Honer Zu Siederdissen C, Maasoumy B, Marra F, Deterding K, Port K, Manns MP, et al. Drug–drug interactions with novel all oral interferon-free antiviral agents in a large real-world cohort. Clin Infect Dis. 2016;62(5):561–7.CrossRefGoogle Scholar
  8. 8.
    Marra F, Leber W, Barclay ST, Christensen S, Ouzan D, Oules V, et al. High prevalence of co-morbidities and complex polypharmacy with drug–drug interaction (DDI) potential in patients with chronic Hepatitis C (CHC). Consistent findings from large primary care databases in the United Kingdom, Germany, and France. Hepatology. 2015;62:725A.Google Scholar
  9. 9.
    Maasoumy B, Zu Siederdissen CH, Marra F, Port K, Deterding K, Manns MP, et al. Prevalence of drug–drug interactions with modern interferon free antiviral regimens against Hepatitis C in a large real-world cohort. Hepatology. 2015;62:767A–8A.Google Scholar
  10. 10.
    Ottman AA, Townsend ML, Hashem MG, DiMondi VP, Britt RB. Incidence of drug interactions identified by clinical pharmacists in veterans initiating treatment for chronic Hepatitis C infection. Ann Pharmacother. 2018;52(8):763–8.CrossRefGoogle Scholar
  11. 11.
    Vermehren J, Peiffer KH, Welsch C, Grammatikos G, Welker MW, Weiler N et al. The efficacy and safety of direct acting antiviral treatment and clinical significance of drug–drug interactions in elderly patients with chronic Hepatitis C virus infection. Aliment Pharmacol Ther. 2016;44(8):856–65.CrossRefGoogle Scholar
  12. 12.
    Langness JA, Nguyen M, Wieland A, Everson GT, Kiser JJ. Optimizing Hepatitis C virus treatment through pharmacist interventions: identification and management of drug–drug interactions. World J Gastroenterol. 2017;23(9):1618–26.CrossRefGoogle Scholar
  13. 13.
    Back DJ, Burger DM. Interaction between amiodarone and sofosbuvir-based treatment for Hepatitis C virus infection: potential mechanisms and lessons to be learned. Gastroenterology. 2015;149(6):1315–7.CrossRefGoogle Scholar
  14. 14.
    Yeoh SW. Iatrogenic cushing syndrome from interaction between ritonavir and oral budesonide during direct acting antiviral Hepatitis C therapy. J Clin Exp Hepatol. 2016;6(3):246–9.CrossRefGoogle Scholar
  15. 15.
    Rose AJ, Fischer SH, Paasche-Orlow MK. Beyond medication reconciliation: the correct medication list. JAMA. 2017;317(20):2057–8.CrossRefGoogle Scholar
  16. 16.
    Phillips M, Wilson JA, Aly A, Wood M, Poyah P, Drost S, et al. An evaluation of medication reconciliation in an outpatient nephrology clinic. Cannt J. 2016;26(2):29–33.Google Scholar
  17. 17.
    Galvin M, Jago-Byrne MC, Fitzsimons M, Grimes T. Clinical pharmacist’s contribution to medication reconciliation on admission to hospital in Ireland. Int J Clin Pharm. 2013;35(1):14–21.CrossRefGoogle Scholar
  18. 18.
    Holland DM. Interdisciplinary collaboration in the provision of a pharmacist-led discharge medication reconciliation service at an Irish teaching hospital. Int J Clin Pharm. 2015;37(2):310–9.CrossRefGoogle Scholar
  19. 19.
    Mekonnen AB, McLachlan AJ, Brien JAE. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. J Clin Pharm Ther. 2016;41(2):128–44.CrossRefGoogle Scholar
  20. 20.
    Pevnick JM, Nguyen C, Jackevicius CA, Palmer KA, Shane R, Cook-Wiens G, et al. Improving admission medication reconciliation with pharmacists or pharmacy technicians in the emergency department: a randomised controlled trial. BMJ Qual Saf. 2018;27(7):512–20.CrossRefGoogle Scholar
  21. 21.
    Milone AS, Philbrick AM, Harris IM, Fallert C. Medication reconciliation by clinical pharmacists in an outpatient family medicine clinic. J Am Pharm Assoc. 2014;54(2):181–7.CrossRefGoogle Scholar
  22. 22.
    Ashjian E, Salamin LB, Eschenburg K, Kraft S, Mackler E. Evaluation of outpatient medication reconciliation involving student pharmacists at a comprehensive cancer center. J Am Pharm Assoc. 2015;55(5):540–5.CrossRefGoogle Scholar
  23. 23.
    van der Gaag S, Janssen MJA, Wessemius H, Siegert CEH, Karapinar-Çarkit F. An evaluation of medication reconciliation at an outpatient Internal Medicines clinic. Eur J Intern Med. 2017;44:e32–4.CrossRefGoogle Scholar
  24. 24.
    Langness JA, Everson GT. Viral hepatitis: drug–drug interactions in HCV treatment–the good, the bad and the ugly. Nat Rev Gastroenterol Hepatol. 2016;13(4):194–5.CrossRefGoogle Scholar
  25. 25.
    Macias J, Monge P, Mancebo M, Merchante N, Neukam K, Real LM, et al. High frequency of potential interactions between direct-acting antivirals and concomitant therapy in HIV/Hepatitis C virus-coinfected patients in clinical practice. HIV Med. 2017;18(7):445–51.CrossRefGoogle Scholar
  26. 26.
    Poizot-Martin I, Naqvi A, Obry-Roguet V, Valantin MA, Cuzin L, Billaud E, et al. Potential for drug–drug interactions between antiretrovirals and HCV direct acting antivirals in a large cohort of HIV/HCV coinfected patients. PLoS ONE. 2015;10(10):e0141164.CrossRefGoogle Scholar
  27. 27.
    World Health Organisation. Guidelines for the screening, care and treatment of persons with chronic Hepatitis C infection. April 2014Google Scholar
  28. 28.
    Organisation WH. ATC/DDD Index 2016. In: Methodology WCCfDS; 2016. Available from: https://www.whocc.no/atc_ddd_index/.
  29. 29.
    Back, D. University of Liverpool HEP Drug Interactions. 2017. Available from: www.hep-druginteractions.org.
  30. 30.
    Micromedex Healthcare Series (database on CD-ROM) Version 5.1. Greenwood Village, Colorado: Thomson Reuters (Healthcare) Inc, 2007Google Scholar
  31. 31.
    Stockley’s Drug Interactions 9th Edition, 2009, London: Pharmaceutical Press.Google Scholar
  32. 32.
    Coghlan M, O'Leary A, Melanophy G, El Sherif O, Bergin C, Norris S. Hepatitis C direct-acting anti-viral treatment options in patients with epilepsy. A drug–drug interaction dilemma in Hepatitis C infection Posters. (Abstracts 1583). Hepatology. 2017;66(S1):149–1185.CrossRefGoogle Scholar
  33. 33.
    Moriarty F, Bennett K, Cahir C, Fahey T. Characterizing potentially inappropriate prescribing of proton pump inhibitors in older people in primary care in Ireland from 1997 to 2012. J Am Geriatr Soc. 2016;64(12):e291–6.CrossRefGoogle Scholar
  34. 34.
    Mogalian E, German P, Kearney BP, Yang CY, Brainard D, McNally J, et al. Use of multiple probes to assess transporter- and cytochrome P450-mediated drug–drug interaction potential of the pangenotypic HCV NS5A inhibitor velpatasvir. Clin Pharmacokinet. 2016;55(5):605–13.CrossRefGoogle Scholar
  35. 35.
    Kiser JJ. Clinically significant drug–drug interactions between Hepatitis C virus and HIV treatments. Top Antivir Med. 2016;24(3):106–10.Google Scholar
  36. 36.
    Cope R, Pickering A, Glowa T, Faulds S, Veldkamp P, Prasad R. Majority of HIV/HCV patients need to switch antiretroviral therapy to accommodate direct acting antivirals. AIDS Patient Care STDS. 2015;29(7):379–83.CrossRefGoogle Scholar
  37. 37.
    Rice DP, Jr., Faragon JJ, Banks S, Chirch LM. HIV/HCV antiviral drug interactions in the era of direct-acting antivirals. J Clin Transl Hepatol. 2016;4(3):234–40.CrossRefGoogle Scholar
  38. 38.
    Burger D, Back D, Buggisch P, Buti M, Craxi A, Foster G, et al. Clinical management of drug–drug interactions in HCV therapy: challenges and solutions. J Hepatol. 2013;58(4):792–800.CrossRefGoogle Scholar
  39. 39.
    Pereira MT, Ferreira L, Horta AA, de Carvalho AC. Exogenous Cushing’s syndrome as a result of ritonavir–budesonide interaction—A case report. HIV AIDS Rev. 2016;15(2):91–3.CrossRefGoogle Scholar
  40. 40.
    Canalejo E, Pacheco MS. Cushing syndrome due to ritonavir–fluticasone interaction. CMAJ. 2012;184(15):1714.CrossRefGoogle Scholar
  41. 41.
    Sicras A, Ferrer V, Navarro R, Saez-Zafra M. SAT-116—Comorbidities, comedication and potential drug to drug interactions in chronic Hepatitis C patients: implications for adequate HCV treatment selection. J Hepatol. 2016;64(2):S747–8.CrossRefGoogle Scholar
  42. 42.
    European Association for the Study of the Liver. Recommendations on Treatment of Hepatitis C 2018. J Hepatol. 2018;69(2):461–511.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Pharmacy DepartmentSt. James’s HospitalDublin 8Ireland
  2. 2.School of MedicineTrinity CollegeDublinIreland
  3. 3.National Centre for PharmacoeconomicsSt. James’s HospitalDublin 8Ireland
  4. 4.Department of GU Medicine and Infectious DiseasesSt. James’s HospitalDublinIreland
  5. 5.Department of HepatologySt. James’s HospitalDublin 8Ireland

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