- Pharmacist-delivered direct-acting antiviral (DAA) therapy yields high HCV clearance rates.
Why this matters
- Expanding HCV care to include clinical pharmacists can help meet national HCV elimination goals.
- Observational study of 1253 HCV+ patients initiating DAA therapy at 4 US institutions with a pharmacist-driven treatment model, January 1, 2014-March 12, 2018.
- Primary outcome: sustained virologic response at ≥12 weeks posttreatment (SVR12).
- Funding: Gilead Sciences.
- Most patients were treatment-naive (81.6%) baby-boomers (birth years, 1945-1965; 74.1%) with HCV-1 (88.4%); 63.9% were male and 53.7% were black.
- 40.3% had cirrhosis (Child-Turcotte-Pugh [CTP] class A, 82.8%).
- Comorbidities included psychiatric illness (33.5%), diabetes (24.2%), and HIV (18%); 31.1% used alcohol within the preceding 6-12 months (illicit substances, 15.9%).
- 60.4% received ledipasvir/sofosbuvir (Harvoni) ±ribavirin.
- Intent-to-treat (ITT) SVR12 was 86.1%.
- Non-SVR12: 54.6% lost to follow-up, 13.8% stopped treatment.
- Per-protocol SVR12 rate (n=1134) was 95.1%.
- ITT SVR12 was lower with cirrhosis (82.2% vs 88.8%), particularly CTP class B (69.4% vs CTP-A, 84.9%).
- Missing ≥1 dose yielded lower SVR12 than full adherence (74.9% vs 90.0%; P<.0001>
- 798 drug-drug interactions were identified at baseline (47.6% of patients); 184 baseline medications were adjusted to optimize DAA safety and efficacy; SVR12 was not compromised (P=.0543).
- Retrospective design.