Pharmacotherapy Profiles in People with Opioid Use Disorders: Considerations for Relevant Drug–Drug Interactions with Antiviral Treatments for Hepatitis C

Andreas Hintz,Anika Moerner,Gero Niess,Mehtap Guendogdu,Frank Tacke,Tim Umland

doi:10.3390/pathogens10060648

Andreas Hintz, Anika Moerner + Show 4 more

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https://doi.org/10.3390/pathogens10060648

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Abstract

People who inject drugs (PWID) are often affected by physical and psychological diseases and prone to co-medication. In Germany, about 50% of PWID are on opioid substitution therapy (OST). Comprehensive data on pharmacotherapy in these patients may help to select antiviral therapy against hepatitis C virus (HCV) infections and avoid drug–drug interactions (DDIs). We compared co-medication profiles based on statutory health insurance prescriptions (IQVIA database) of PWID (n = 16,693), OST (n = 95,023) and treated HCV patients (n = 7886). Potential DDIs with the most widely used HCV direct-acting agents (Sofosbuvir/Velpatasvir, Glecaprevir/Pibrentasvir and Elbasvir/Grazoprevir) were evaluated based on the Liverpool DDI database. Co-medication was present in 57% of PWID, 57% of OST, 44% of patients on HCV therapy and 46% in a subgroup receiving OST+HCV therapy (n = 747 of 1613). For all groups, co-medication belonging to ATC-class N (nervous system) was most commonly prescribed (in 75%, 68%, 41% and 62% of patients, respectively). Contraindications (i.e., DDIs precluding HCV therapy) were infrequent (0.4–2.5% of co-medications); potential DDIs with HCV therapies were shown for 13–19% of co-medications, namely for specific substances including some analgesics, antipsychotics, anticoagulants, lipid lowering drugs and steroids. In conclusion, concomitant pharmacotherapy is common and clinically relevant when treating HCV infection in PWID.

Highlights

The prevalence of chronic hepatitis C among people who inject drugs (PWID) in Germany was found to be between 42% and 75% depending on the region in the crosssectional DRUCK Study in 2015 [1,2]
For three patient cohorts and a subgroup of one of the patient’s cohort, all comedications were compiled for the defined periods, and, in a second step, they were examined for potential drug–drug interactions (DDIs) with regard to state-of-the art direct acting antivirals (DAAs) in hepatitis C virus (HCV) therapy
Of 16,693 PWID who started drug substitution therapy in moving annual target (MAT) September 2019 and had no opioid substitution therapy (OST) in the preceding year, n = 7176 (43%) received no co-medication, n = 9517 (57%) had one or more comedications and n = 9296 had at least one co-medication that could be evaluated for potential DDIs (98% of co-medications)

Summary

Introduction

The prevalence of chronic hepatitis C among people who inject drugs (PWID) in Germany was found to be between 42% and 75% depending on the region in the crosssectional DRUCK Study in 2015 [1,2]. To achieve the WHO’s proclaimed goal of hepatitis C virus (HCV) elimination by 2030, the special needs of this group have to be recognized. Much shorter duration of treatment compared to prior options, coupled with fewer side effects and easy oral application of direct acting antivirals (DAAs), has facilitated and improved HCV therapy considerably. German guidelines acknowledge the need and feasibility of treating PWID, especially in the context of substitution therapy and under close monitoring [4]. People on opioid substitution therapy (OST) can be effectively cured from

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