Resource utilization associated with the management of potential interactions between direct-acting antivirals for chronic hepatitis C treatment and cardiovascular and central nervous system drugs

Abstract

Objective: Patients with chronic Hepatitis C Virus Infection (HCV) present high rates of comorbidity and polypharmacy. We aimed to assess the additional actions and resource utilization required for the management of potential drug-drug interactions (pDDIs) in HCV patients showing cardiovascular (CVS) and central nervous system (CNS) comorbidities, treated with sofosbuvir/velpatasvir (SOF/VEL) compared to glecaprevir/pibrentasvir (GLE/PIB) in routine clinical practice in Spain. Methods: The most prevalent CVS and CNS drugs in HCV patients were identified from real-world published data. The pDDIs between SOF/VEL, GLE/PIB and comedications, and their management recommendations were identified on the University of Liverpool Hepatitis Drug Interaction Group website. An expert panel defined real-world management of pDDIs, and a consensus was reached on actions required on the concomitant drug and resource utilization. Results: Additional actions are required in 89% of the CVS drugs when co-administered with GLE/PIB, while 39% were required with SOF/VEL (dose adjustment: 39% vs 17%; drug suspension: 28% vs 11%; drug substitution: 22% vs 11%; drug restart after DAA treatment: 33% vs 22%); additional visits and/or tests are needed in 50% and 22%, respectively. Regarding CNS drugs, 71% required additional actions when co-administered with GLE/PIB, while 14% require them with SOF/VEL (dose adjustment: 57% vs 0%; drug substitution: 14% vs 14%); additional visits and/or tests are needed in 71% and 14%, respectively. Conclusion: In routine clinical practice, fewer actions and less resource utilization are needed to manage pDDIs with SOF/VEL than with GLE/PIB, when treating HCV patients with CVS and CNS comorbidities. Keywords: chronic hepatitis C; drug-drug interactions; pangenotypic direct acting antivirals; resource utilization; comorbidity.