Medication use and medical comorbidity in patients with chronic hepatitis C from a US commercial claims database

Abstract

Background With the advent of the direct-acting antiviral agents (DAAs), significant drug-drug interaction (DDI) potential now exists for patients treated for chronic hepatitis C virus (HCV) infection. However, little is known about how often patients with HCV use medications that may interact with newer HCV treatments, especially those with CYP3A DDI potential. Methods Using a large United States commercial insurance database, medication use and comorbidity burden was examined among adult patients with a chronic HCV diagnosis from 2006-2010. Medications were examined by total number of prescription claims, proportion of patients exposed, and DDI potential with prototypical CYP3A DAAs, boceprevir and telaprevir, for which data were available. Results Patient comorbidity burden was high and increased over the study period. Medication use was investigated in 53,461 patients with chronic HCV. Twenty-one (53%) of the top 40 most utilized medications were classified as having interaction potential, with 62% of patients received at least one of the top 22 interacting medications by exposure. Of these, 59% and 41% were listed in a common DDI resource but not in medication prescribing information, 77% and 77% had not been investigated in DDI studies, 32% and 27% did not have clear recommendations for DDI management, and only 14% and 23% carried a recommendation to avoid coadministration for boceprevir and telaprevir, respectively. Conclusion Practitioners may expect a medication with CYP3A DDI potential in two-thirds of patients with HCV and almost one-half of the most frequently used medications. However, DDI potential may not be reflected in prescribing information.

Managing drug–drug interactions with new direct‐acting antiviral agents in chronic hepatitis C

“…This transporter is involved in the hepatic influx of some drugs such as statins (pravastatin, rosuvastatin) . Simeprevir, daclatasvir, ledipasvir, paritaprevir and ritonavir are all substrates and inhibitors of the OATP1B1 transporter, whereas sofosbuvir, ombitasvir and dasabuvir are not substrates . In healthy subjects, administration of a single dose of rosuvastatin with simeprevir or daclatasvir at 60 mg once daily or 3D regimen results in a respectively AUC increase by 181%, 58% and 159%, by blocking their hepatic uptake .…”

“…Transporters involved in drug-drug interaction of new DAAs Drug-drug interactions and new DAAs are not substrates [8][9][10][11][12][13][14][15][16][17][18][19]. In healthy subjects, administration of a single dose of rosuvastatin with simeprevir or daclatasvir at 60 mg once daily or 3D regimen results in a respectively AUC increase by 181%, 58% and 159%, by blocking their hepatic uptake [18, 28,33].…”

Drug–Drug Interaction of Omeprazole With the HCV Direct‐Acting Antiviral Agents Paritaprevir/Ritonavir and Ombitasvir With and Without Dasabuvir

“…Proton pump inhibitors such as omeprazole are among the most commonly used drugs worldwide and are now available for use without a prescription for several gastric acid–related disorders. In a study of 197 381 HCV‐infected patients in a commercial claims database, omeprazole was the 11th most commonly used medication . Omeprazole increases gastric pH by reducing gastric acid secretion from parietal cells that line the stomach .…”

“…In a study of 197 381 HCV-infected patients in a commercial claims database, omeprazole was the 11th most commonly used medication. 15 Omeprazole increases gastric pH by reducing gastric acid secretion from parietal cells that line the stomach. [16][17][18] Omeprazole is indicated to be given 1 hour before a meal.…”

Drug–drug interactions of telaprevir and boceprevir in HCV‐monoinfected and HIV/HCV‐coinfected patients can modify the adherence

“…Our results are in agreement with previously published studies. A recent study evaluating more than 5000 HCV‐infected patients reported that DDIs with baseline medication could be expected in two‐thirds of patients using CYP3A4 inhibitors . Moreover, Maasoumy et al .…”