CP-154 Effect of regimen complexity on the premature discontinuation of treatment with boceprevir or telaprevir in hepatitis C Virus-HIV coinfected patients

Abstract

Background Medication regimen complexity index (MRCI) has been identified as a predictor of sustained virologic response in patients treated with peginterferon and ribavirin for chronic hepatitis C. Purpose To determine the influence of the MRCI in the premature discontinuation of triple therapy treatment with boceprevir or telaprevir in hepatitis C virus-HIV (HCV/HIV) coinfected patients. Material and methods We conducted a multicentre and prospective study that included HCV/HIV coinfected patients treated with triple therapy with boceprevir or telaprevir in combination with peginterferon-alpha plus ribavirin between January and December 2013. Basal variables colleted were: age, gender, hepatits C treatment-naive or previously treated, presence of cirrhosis, psiquiatric disorder. We evaluated the proportion of patients achieve extended rapid virologic response (RVRe), defined as HCV RNA negative between 4 and 12 weeks of treatment with telaprevir and between 8 and 24 weeks of treatment with boceprevir. The rate of premature therapy discontinuation with the PI and reasons were collected. To calculate the MRCI, we considered all prescribed drugs and used the tool developed by McDonald et al . 1 To determine the independent predictors of therapy discontinuation, we performed a multivariate logistic regression analysis. Results 55 patients of three different centres were included (86.4% were men and the mean age was 48 years (SD = 3.7)). 68.0% were non-naive. 90.7% had cirrhosis. 83.1% achieved RVRe. 18 patients (30.5%) prematurely discontinued the treatment. Reasons for treatment discontinuation included adverse events (50.0%), lack of efficacy (33.0%) and refusal to continue the medication (17.0%). The mean MRCI was significantly higher in patients who discontinued the therapy (31.11 vs. 26.16). In the multivariate analysis, the only predictor of premature discontinuation of the therapy was the MRCI (OR = 1.17, p = 0,009; 95% CI (1.04–1.53). Conclusion The MRCI is an independent predictor of premature discontinuation of the triple therapy with boceprevir and telaprevir in HCV/HIV coinfected patients. References and/or Acknowledgements 1 McDonald MV, Peng TR, Sridharan S, et al . Automating the medication regimen complexity index. J Am Med Inform Assoc 2013;20(3):499–505 No conflict of interest.