Cohen Stanley Martin, Kwasny Mary J, Ahn Joseph
Section of Hepatology, Rush University Medical Center, Chicago, IL 60612, USA.
Ann Pharmacother. 2009 Feb;43(2):202-9. doi: 10.1345/aph.1L227. Epub 2009 Feb 3.
Treatment for hepatitis C virus (HCV) is associated with significant adverse events. Improved adherence increases the probability of achieving sustained virologic response (SVR). Despite a lack of supporting literature, the use of specialty care pharmacies has increased in recent years in an attempt to improve HCV treatment outcomes.
To compare specialty care versus standard retail pharmacies in HCV treatment outcomes, utilization of office resources, and the use of supplemental medications.
A retrospective chart review was performed at a single academic institution for adults with HCV infection treated between 2001 and 2006. SVR was the primary endpoint. Secondary endpoints included therapy completion rates, HCV treatment dose reductions, additional phone calls and clinic visits, and the use of supplemental medications.
One hundred ninety-seven patients were identified (102 standard and 95 specialty care pharmacy). There were no differences in baseline demographics between the groups, except for a higher proportion of African Americans using specialty care pharmacies. Overall SVR was 103/197 (52%). SVR was 57/102 (56%) in the standard pharmacy group and 46/95 (48%) in the specialty care pharmacy group. There were no statistically significant differences with regard to SVR (even after accounting for differences in ethnicity), the use of supplemental medications, additional clinic phone calls and visits required, and the reasons for HCV therapy discontinuation. There was a statistically significantly higher incidence of HCV medication dose reductions in the standard retail pharmacy group (45% vs 28%; p = 0.016).
The use of specialty care pharmacies for the treatment of HCV was not associated with higher SVR rates. Patients using specialty care pharmacies had a lower incidence of interferon and/or ribavirin dose reductions, but there was no difference between the groups in therapy completion rates, use of additional office resources, or use of supplemental medications.
丙型肝炎病毒（HCV）治疗与显著的不良事件相关。提高依从性可增加实现持续病毒学应答（SVR）的可能性。尽管缺乏相关文献支持，但近年来专科护理药房的使用有所增加，以期改善HCV治疗效果。
比较专科护理药房与标准零售药房在HCV治疗效果、办公资源利用及辅助药物使用方面的差异。
对一所学术机构2001年至2006年间治疗的成年HCV感染患者进行回顾性病历审查。SVR为主要终点。次要终点包括治疗完成率、HCV治疗剂量减少情况、额外的电话咨询和门诊就诊次数以及辅助药物的使用。
共识别出197例患者（102例使用标准药房，95例使用专科护理药房）。两组患者的基线人口统计学特征无差异，但使用专科护理药房的非裔美国人比例较高。总体SVR为103/197（52%）。标准药房组的SVR为57/102（56%），专科护理药房组为46/95（48%）。在SVR方面（即使考虑种族差异后）、辅助药物的使用、所需额外门诊电话咨询和就诊次数以及HCV治疗中断原因方面，均无统计学显著差异。标准零售药房组HCV药物剂量减少的发生率在统计学上显著更高（45%对28%；p = 0.016）。
使用专科护理药房治疗HCV与更高的SVR率无关。使用专科护理药房的患者干扰素和/或利巴韦林剂量减少的发生率较低，但两组在治疗完成率、额外办公资源的使用或辅助药物的使用方面无差异。
