National Survey of Hepatitis C Treatment Practice Patterns in the Era of Direct-Acting Antiviral Therapy

Abstract

Introduction: Hepatitis C virus (HCV) therapy is amidst a revolution with the introduction of directacting antiviral (DAA) therapy. The aims of our study were to: 1.) characterize provider attitudes and practice patterns for HCV after introduction of DAA therapy in the United States, and 2.) identify patient characteristics driving provider treatment decisions. Methods: We conducted a national web-based survey among providers treating HCV patients 5 months after the AASLD/IDSA published the HCV practice guidelines. The survey included questions on pretherapy evaluation, on-treatment management, and clinical vignettes. Stepwise multivariate logistic regression was performed to determine associations between provider characteristics and HCV treatment practice patterns. Results: Of 1,179 deliverable emails, 125 (10.6%) clinicians responded. The majority of providers were male (64%) and part of an academic practice (74%). Thirty-nine percent of providers had been in practice <10 years, 33% for 11-20 years, and 28% for more than 20 years. All but 8% of providers had treated HCV patients in the past year, with nearly one-third treating more than 1 patient per week. Of those who treated HCV patients, 91% reported continued use of PEG-interferon (IFN) in selected patients. Providers reported being more likely to treat patients with psychiatric comorbidities (85%), decompensated cirrhosis (84%), and cytopenia (89%), given availability of DAA agents. The most important factors for selecting HCV treatment regimens were efficacy (96%), side effect profile (69%), duration of treatment (41%), and number of pills (40%). Cost (22%) and ease of prescribing (5%) were not considered important factors. The majority of providers (62%) prefer to defer therapy in genotype 1 HCV patients with mild fibrosis, but only a minority defer if genotype 3 (39%) or genotype 4 (49%). In genotype 1 patients with advanced fibrosis, most providers (49%) use sofosbuvir (SOF) + simeprevir (SIM) combination therapy, while 37% use SOF + PEG-IFN and RBV. The proportion using SOF + SIM was higher among patients who had failed prior PEG-IFN therapy (65%) or were post-transplant (62%). Most common therapy in genotype 3 HCV with advanced fibrosis was SOF and RBV (57%), while the most common in genotype 4 was SOF + PEG-IFN and RBV (46%). Conclusion: Providers preferentially use IFN-free regimens for HCV and are more willing to treat difficult-to-treat subgroups such as those with psychiatric comorbidities and decompensated cirrhosis. Efficacy, safety, and duration of treatment were the most important factors driving choice of HCV regimen. The survey results are consistent with AASLD/IDSA HCV guidelines published in January 2014. Disclosure - Dr. Alqahtani - Advisroy committees: Gilead, Janssen. Grant/Reserach support: Gilead, Merck; Dr. Sulkowski - Advisory Committees: Pfizer; Consulting: Merck, AbbVie, BIPI, Vertex, Janssen, Gilead, BMS; Grant/Research Support: Merck, AbbVie, BIPI, Vertex, Janssen, Gilead; Dr. Gurakar - Advisory Committees: Gilead, Research Support: BMS.DR. Durand- Grant/Research Support: Gilead, BMS.