Effective Clinical Pharmacist Specialist Management of Direct-Acting Antiviral Treatment for HCV

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Use of clinical pharmacist specialists to manage DAA therapy in HCV-infected patients may improve treatment success.
Use of clinical pharmacist specialists to manage DAA therapy in HCV-infected patients may improve treatment success.

Using clinical pharmacist specialists (CPS) for the management of therapy with direct-acting antivirals (DAAs) in patients with  hepatic C virus (HCV) infection leads to improved sustained virologic rates (SVRs), according to a study published in the Journal of Pharmacy Practice.  

Researchers at the Veterans Affairs (VA) Sierra Nevada Health Care System assessed the potential roles and outcomes of  an outpatient-based HCV treatment clinic (HCVTC) managed by a CPS in partnership with an infectious disease physician.

Between November 1, 2014, and November 30, 2015, a total of 132 veterans infected with HCV were managed by a CPS who engaged in pretreatment screening, drug selection, patient education, medication counseling, drug therapy monitoring, drug utilization review, addressing issues on drug adherence, and routine and posttreatment follow-up of patients.

During this time, 87 patients were treated with ledipasvir/sofosbuvir, 29 patients were treated with paritaprevir/ritonavir/ombitasvir + dasabuvir, and 16 patients were treated with sofosbuvir-based regimens.  After 12 weeks of treatment, an SVR rate of 92%, 100%, and 93.8%, was achieved for each of the treatment regimens, respectively.

The overall SVR rate was 94% across all genotypes, with an SVR rate of 93% in treatment-naive patients, 96% in treatment-experienced patients, 93% in patients without cirrhosis, and 94% in patients with compensated cirrhosis.

In comparison, a report based on VA national electronic data from 17,487 veterans with HCV infection treated with similar DAA-based regimens from January 1, 2014, to June 30, 2015, showed an overall SVR rate of 91% across all genotypes, with an SVR rate of 91% in treatment-naïve patients, 90% in treatment-experienced patients, 92% in patients without cirrhosis, and 87% in patients with compensated cirrhosis.

The authors concluded that “the collaborative partnership between an [infectious disease physician] and CPS displayed a concerted effect in achieving higher SVR rates and HCV treatment success in our HCVTC patients.”

Reference

Mikolas LA, Jacques K, Huq M, Krasner C, Mambourg SE. Utilizing clinical pharmacist specialist to manage hepatitis C virus patients on direct-acting antiviral therapy [published online May 21, 2018]. J Pharm Pract. doi: 10.1177/0897190018777345

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