Tu1059 Decompensation, Hepatocellular Carcinoma, Liver Related Hospital Admission and Liver Related Mortality After Antiviral Treatment: How Wiser Are We at the End of the Era of Conventional Dual Antiviral Therapy for Chronic Hepatitis C?

Abstract

Background and aims: The CDC estimates that 75% of the U.S. CHC population is between 50 and 70 years of age. As this population ages, the increasing rates of significant comorbidities including end stage liver disease will make CHC management more challenging. Drug-drug interactions from medications used to treat these comorbidities may also contraindicate or complicate the use of cytochrome P-450 metabolized protease inhibitors commonly used in anti-HCV regimens. The purpose of this study is to measure the rates of comorbidities and medications that may create barriers towards initiating anti-HCV regimens in a large U.S. CHC cohort. Methods: This was a retrospective database study of a large U.S. cohort of insured patients with CHC from 1/1/2009 to 6/30/2014. Patients with CHC were identified through ICD-9 coding. A total of 80,112 patients were analyzed: 76,115 with commercial and 3,997 with Medicaid insurance. Results: Two-thirds (66%) of our CHC population were aged between 50 and 70 years, 61% were male, and 11% were women of child-bearing age. Nearly 70% of patients had at least one significant comorbidity such as hypertension (49%), diabetes (22%), coronary artery disease (1.8%), HIV (4%), asthma or COPD (16%), chronic kidney disease (2%), and depression (14%). In addition, nearly one-third of patients (30%) had evidence for end stage liver disease with ascites, hepatic encephalopathy, or esophageal varices. Across the entire study period, the median number of first-time filled prescriptions for any medication per year was 3.5 (IQR, 1 to 8). Patients with comorbidities had a significantly higher median number of first-time filled prescriptions per year as compared to those without comorbidities (median 5 (IQR, 2 to 11) prescriptions per year with comorbidities versus median 1.5 (IQR, 0.5 to 3.5) prescriptions per year without comorbidities. Most commonly prescribed P-450 metabolized medications were HMG-CoA reductase inhibitors (13%), anxiolytics (18%), antibiotics (21%), and calcium channel blockers (14%). In addition, there were significantly more prescriptions for P-450 metabolized medications in patients with comorbidities (67%) compared to those without comorbidities (41%) (Figure 1). Conclusions: In this analysis of a large U.S. cohort of CHC patients, the majority (70%) of patients had at least one comorbid diagnosis of hypertension, diabetes, coronary artery disease, COPD, chronic kidney disease, or depression. In this population, approximately 67% also had at least one prescription for a P-450 metabolized medication that may pose significant drug-drug interactions with some of the anti-HCV protease inhibitors. Therefore, there may be significant barriers to treatments with current and upcoming antiHCV regimens in a significant proportion of patients with CHC.