Drug interactions between buprenorphine, methadone and hepatitis C therapeutics

Ogbuagu, Onyema; Friedland, Gerald; Bruce, R. Douglas

doi:10.1080/17425255.2016.1183644

Cited by 10 publications

(7 citation statements)

References 76 publications

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“…Second, data related to the dose of methadone were not available and we also lacked data on treatment adherence and potential pharmacological interactions that might have led to DAA discontinuation. However, few studies have reported significant pharmacological interactions between DAAs and methadone[ 26 , 27 ]. Although some DAAs can increase the methadone or buprenorphine concentrations in blood, dose adjustments are not required, and monitoring withdrawal symptoms is merely recommended[ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, few studies have reported significant pharmacological interactions between DAAs and methadone[ 26 , 27 ]. Although some DAAs can increase the methadone or buprenorphine concentrations in blood, dose adjustments are not required, and monitoring withdrawal symptoms is merely recommended[ 27 , 28 ]. Third, we could have underestimated the HCV treatment rate with DAAs because some anti HCV-positive patients were considered treatment eligible without having a confirmatory RNA-HCV test.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study

Sanvisens¹,

Rivas²,

Faure³

et al. 2020

WJG

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BACKGROUND Direct-acting antivirals (DAAs) are recommended for the treatment of hepatitis C virus (HCV) infection in patients treated with methadone or buprenorphine. AIM To assess HCV treatment rates in an Opioid Treatment Program (OTP). METHODS This longitudinal study included 501 patients (81.4% men, median age: 45 years; interquartile range: 39-50 years) enrolled in an OTP between October 2015 and September 2017. Patients were followed until September 2019. Data on socio-demographics, substance use, HCV infection, human immunodeficiency virus (HIV) infection and laboratory parameters were collected at entry. We analyzed medical records to evaluate HCV treatment. Kaplan-Meier methods and Cox regression models were used to analyze the DAA treatment uptake and to identify treatment predictors. RESULTS Prevalence of HCV and HIV infection was 70% and 34%, respectively. Among anti-HCV-positive ( n = 336) patients, 47.2%, 41.3%, and 31.9% used alcohol, cannabis, and cocaine, respectively. HCV-RNA tests were positive in 233 (69.3%) patients. Twentyeight patients (8.3%) cleared the infection, and 59/308 (19.1%) had received interferon-based treatment regimens before 2015. Among 249 patients eligible, 111 (44.6%) received DAAs. Treatment rates significantly increased over time from 7.8/100 person-years (p-y) (95%CI: 5.0-12.3) in 2015 to 18.9/100 p-y (95%CI: 11.7-30.3) in 2019. In a multivariate analysis, patients with HIV co-infection were twice as likely to receive DAAs (HR = 1.94, 95%CI: 1.21-3.12) than patients with HCV mono-infection. Current drug use was an independent risk factor for not receiving treatment against infection (HR = 0.48, 95%CI: 0.29-0.80). CONCLUSION HCV treatment is evolving in patients with HCV-HIV co-infection. Ongoing drug use while in an OTP might negatively impact the readiness to treat infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study

Sanvisens¹,

Rivas²,

Faure³

et al. 2020

WJG

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“…In terms of safety and efficacy, several DAA combinations have been shown to be highly effective for infected patients who are injecting drug and OST users, achieving SVR rates similar to those in patients who acquired HCV infection from other sources . Furthermore, currently available DAAs do not present major drug–drug interactions with OST . Consequently, the decision to delay or defer HCV treatment in this population should be related to other factors as perceived by clinicians and not to expected treatment success.…”

Section: Discussionmentioning

confidence: 99%

Parenteral drug use as the main barrier to hepatitis C treatment uptake in HIV‐infected patients

et al. 2019

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ObjectivesOur objective was to identify patient factors associated with being untreated for hepatitis C virus (HCV) infection in HIV-coinfected patients. MethodsA prospective longitudinal study was carried out. HIV-infected patients with active chronic HCV infection included in the HERACLES cohort (NCT02511496) constituted the study population. The main study outcome was receipt of HCV direct-acting antiviral (DAA) treatment from 1 May 2015 to 1 May 2017. The population was divided into patients who were receiving HCV treatment during follow-up and those who were not. ResultsOf the 15 556 HIV-infected patients in care, 3075 (19.7%) presented with chronic HCV infection and constituted the study population. At the end of the follow-up, 1957 patients initiated HCV therapy (63.6%). Age < 50 years, absence of or minimal liver fibrosis, being treatment-na€ ıve, HCV genotype 3 infection, being in the category of people who inject drugs using opioid substitutive therapy (OST-PWID), and being in the category of recent PWID were identified as significant independent risk factors associated with low odds of DAA implementation. When a multivariate analysis was performed including only the PWID population, both OST-PWID [odds ratio (OR) 0.552; 95% confidence interval (CI) 0.409-0.746) and recent PWID (OR 0.019; 95% CI 0.004-0.087) were identified as independent factors associated with low odds of treatment implementation.We identified factors, which did not include prioritization of a DAA uptake strategy, that limited access to HCV therapy. The low treatment uptake in several populations seriously jeopardizes the elimination of HCV infection in the coming years.

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“…Consequently, specific drug combinations have been noted to alter opioid drug levels. Despite common metabolic pathways, studies to date have shown no significant signs and symptoms of opioid withdrawal or toxicity that would preclude concurrent administration (Table 2) 90 .…”

Section: Efficacy Of Hcv Treatment In Patients On Oatmentioning

confidence: 99%

Treatment of Chronic Hepatitis C in Patients Receiving Opioid Agonist Therapy

Norton

Akiyama

Zamor

et al. 2018

Infectious Disease Clinics of North America

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Injection drug use is the most common transmission route for hepatitis C. High rates of infection are observed among individuals on opioid agonist therapy. Although people who inject drugs carry the highest burden, few have initiated treatment. We present a comprehensive review of the evidence on the efficacy of HCV medications, drug-drug interactions, and barriers to and models of care. Studies have demonstrated comparable efficacy for individuals who are on opioid agonist therapy compared with those who are not. We propose that a strategy of treatment and cure-as-prevention is imperative in this population to curb the hepatitis C epidemic.

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Drug interactions between buprenorphine, methadone and hepatitis C therapeutics

Cited by 10 publications

References 76 publications

Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study

Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study

Parenteral drug use as the main barrier to hepatitis C treatment uptake in HIV‐infected patients

Treatment of Chronic Hepatitis C in Patients Receiving Opioid Agonist Therapy

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