The high comorbidity burden of the hepatitis C virus infected population in the United States

Louie, Karly S.; Laurent, Samantha St.; Forssén, Ulla M.; Mundy, Linda M.; Pimenta, Jeanne M.

doi:10.1186/1471-2334-12-86

Cited by 81 publications

(87 citation statements)

References 33 publications

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“…A small cross-sectional retrospective study investigating comorbidities associated with HCV from 1998 to 2007 found that HIV/AIDS, renal disease, diabetes, and obesity were more prevalent in patients with HCV compared with the U.S. population [27]. Higher comorbidity rates may reflect the selective age distribution of the HCV population, but there is also some recent evidence that comorbidity rates may be higher in the HCV population even after adjusting for age [17]. In our study, the potential increasing comorbidity rates may be related to the increasing average age of the underlying HCV population and have implications for increasing polypharmacy and complexity of DDI assessment.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, comorbidities that were reported previously as highly prevalent in chronic HCV patients or otherwise believed to be clinically relevant were identified for each 1-year cross-sectional cohort in either the inpatient or outpatient files using compiled ICD-9 code definitions from the medical literature (Appendix A) [17, 18]. Compensated cirrhosis was defined directly by ICD-9 code definition; advanced liver disease was a composite definition representing decompensated disease and included codes for ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, esophageal varices, hepatorenal syndrome, or hepatocellular carcinoma.…”

Section: Methodsmentioning

confidence: 99%

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

Lauffenburger

Mayer

Hawke

et al. 2014

European Journal of Gastroenterology &Amp; Hepatology

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Lauffenburger

Mayer

Hawke

et al. 2014

European Journal of Gastroenterology &Amp; Hepatology

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“…It is a leading cause of liver disease, cirrhosis, hepatocellular carcinoma, and liver transplantation (Lauer & Walker, 2001), and is associated with very high medical and psychiatric comorbidity (Butt et al, 2007; Louie et al, 2012). …”

Section: Introductionmentioning

confidence: 99%

Biopsychosocial factors associated with pain in veterans with the hepatitis C virus

et al. 2013

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Background Little research has examined etiological factors associated with pain in patients with the hepatitis C virus (HCV). The purpose of this study was to evaluate the relationship between biopsychosocial factors and pain among patients with HCV. Methods Patients with HCV and pain (n=119) completed self-report measures of pain, mental health functioning, pain-specific psychosocial variables (pain catastrophizing, self-efficacy for managing pain, social support), prescription opioid use, and demographic characteristics. Results In multivariate models, biopsychosocial factors accounted for 37% of the variance in pain severity and 56% of the variance in pain interference. In adjusted models, factors associated with pain severity include pain catastrophizing and social support, whereas variables associated with pain interference were age, pain intensity, prescription opioid use, and chronic pain self-efficacy (all p-values<0.05). Conclusions The results provide empirical support for incorporating the biopsychosocial model in evaluating and treating chronic pain in patients with HCV.

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“…Comorbidities, such as diabetes and obesity, are more common among patients with hepatitis C virus infection than in the general U.S. population, with as many as 25% of patients with hepatitis C virus infection at risk of comorbid disorders of lipid metabolism (2). Thus, patients with hepatitis C virus infection frequently receive concomitant treatments for hyperlipidemia, including the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors atorvastatin and pravastatin.…”

mentioning

confidence: 99%

Pharmacokinetic Evaluation of the Interaction between Hepatitis C Virus Protease Inhibitor Boceprevir and 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors Atorvastatin and Pravastatin

Hulskotte

Feng

Xuan

et al. 2013

Antimicrob Agents Chemother

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bBoceprevir is a potent orally administered inhibitor of hepatitis C virus and a strong, reversible inhibitor of CYP3A4, the primary metabolic pathway for many 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors. Thus, the aim of the present study was to investigate drug-drug interactions between atorvastatin or pravastatin and boceprevir. We conducted a single-center, open-label, fixed-sequence, one-way-crossover study with 20 healthy adult volunteers. Subjects received single-dose atorvastatin (40 mg) or pravastatin (40 mg) on day 1, followed by boceprevir (800 mg three times daily) for 7 to 10 days. Repeat single doses of atorvastatin or pravastatin were administered in the presence of steady-state boceprevir. Atorvastatin exposure increased in the presence of boceprevir, with atorvastatin area under the concentrationtime curve from time zero to infinity after single dosing (AUC inf ) increasing 2.3-fold (90% confidence interval [CI], 1.85, 2.90) and maximum observed concentration in plasma (C max ) 2.7-fold (90% CI, 1.81, 3.90). Pravastatin exposure was slightly increased in the presence of boceprevir, with pravastatin AUC inf increasing 1.63-fold (90% CI, 1.03, 2.58) and C max 1.49-fold (90% CI, 1.03, 2.14). Boceprevir exposure was generally unchanged when the drug was coadministered with atorvastatin or pravastatin. All adverse events were mild and consistent with the known safety profile of boceprevir. The observed 130% increase in AUC of atorvastatin supports the use of the lowest possible effective dose of atorvastatin when coadministered with boceprevir, without exceeding a maximum daily dose of 40 mg. The observed 60% increase in pravastatin AUC with boceprevir coadministration supports the initiation of pravastatin treatment at the recommended dose when coadministered with boceprevir, with close clinical monitoring. W orldwide, there are an estimated 130 to 170 million individuals infected with hepatitis C virus (1). Comorbidities, such as diabetes and obesity, are more common among patients with hepatitis C virus infection than in the general U.S. population, with as many as 25% of patients with hepatitis C virus infection at risk of comorbid disorders of lipid metabolism (2). Thus, patients with hepatitis C virus infection frequently receive concomitant treatments for hyperlipidemia, including the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors atorvastatin and pravastatin. Understanding potential drug interactions between hepatitis C therapies and HMG-CoA reductase inhibitors is important for optimal treatment of this patient population.Boceprevir is a potent, orally administered ketoamide inhibitor targeting the active site of the hepatitis C virus nonstructural protein 3 (NS3) protease, approved for the treatment of genotype 1 chronic hepatitis C virus infection in adult patients with compensated liver disease (3-6). Addition of boceprevir to a pegylated interferon (peginterferon)-ribavirin backbone is associated with significantly increased rates of sustain...

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The high comorbidity burden of the hepatitis C virus infected population in the United States

Cited by 81 publications

References 33 publications

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

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

Biopsychosocial factors associated with pain in veterans with the hepatitis C virus

Pharmacokinetic Evaluation of the Interaction between Hepatitis C Virus Protease Inhibitor Boceprevir and 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors Atorvastatin and Pravastatin

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