Direct-Acting Antiviral Therapy Uptake Examined Among HCV Patients

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Patients with HCV infection, the uptake of direct-acting antiviral therapy increased through quarter 2 of 2015 but then declined.
Patients with HCV infection, the uptake of direct-acting antiviral therapy increased through quarter 2 of 2015 but then declined.

Follow-up analysis of data obtained from the Chronic Hepatitis Cohort Study (CHeCS) found that, in patients with hepatitis C virus (HCV) infection, the uptake of direct-acting antiviral (DAA) therapy increased through quarter 2 of 2015 but then declined and plateaued for the remainder of 2015 and all of 2016.

The study utilized data from the CHeCS, an observational cohort study, to assess demographic and clinical characteristics associated with DAA use. The study authors explained, “Uptake was defined as the proportion of patients infected with HCV as of December 31, 2013 who initiated a DAA regimen from January 1, 2014-December 31, 2016.”

Of the 9,508 patients included in the cohort, 24.2% (N=2,297) initiated DAA therapy. Data analysis showed that the number of DAA initiations peaked in the 2nd quarter of 2015, but then declined and plateaued for the remainder of the study period. 

The study authors reported, “Factors independently associated with initiation included older age (adjusted odds ratios [aORs] 1.7 and 1.7 for age groups 51-60 and 61-70 years, respectively, vs. age <30 years), higher annual income (aORs 1.4 and 1.2 for income >$50K and $30K-$50K, respectively, vs. <$30K), higher FIB4 score (aORs 2.2, 2.1, and 1.6 for FIB4 >5.88, 3.25-5.88, 2.0-<3.25, respectively, vs. <2.0), pre-2014 treatment failure (aOR 1.9, vs. treatment-naive), and longer duration of continuous follow-up (aOR 4.9 for ≥3 years, vs. <3 years).”

Additionally, data analysis found a lower likelihood of initiation in patients of non-Hispanic Black race/ethnicity (aOR: 0.8 vs non-Hispanic Whites), in patients with Medicaid coverage (aOR: 0.4 vs private insurance), and in patients with genotype 3 infection (aOR: 0.7 vs genotype 1).

In HCV-infected patients, DAA uptake was found to increase until halfway through 2015, but then declined and plateaued through 2016. The study authors concluded, “The decline in initiations after a peak in Q2 2015 might reflect the effects of targeting and treating patients 'warehoused' after previous treatment failures.”

Reference:

Spradling PR et al. Uptake of and Factors Associated with Direct-Acting Antiviral Therapy Among Patients Infected with Hepatitis C Virus in the Chronic Hepatitis Cohort Study, 2014-2016. Presented at AASLD The Liver Meeting 2018. Study number 0585.

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