Lauffenburger Julie C, Mayer Christina L, Hawke Roy L, Brouwer Kim L R, Fried Michael W, Farley Joel F
aUNC Eshelman School of Pharmacy bUNC Liver Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Eur J Gastroenterol Hepatol. 2014 Oct;26(10):1073-82. doi: 10.1097/MEG.0000000000000152.
With the advent of the direct-acting antiviral agents, significant drug-drug interaction (DDI) potential now exists for patients treated for chronic hepatitis C virus (HCV) infection. However, little is known about how often patients with HCV infection use medications that may interact with newer HCV treatments, especially those with cytochrome P450 3A (CYP3A) DDI potential.
Using a large US commercial insurance database, medication use and comorbidity burden were examined among adult patients with a chronic HCV diagnosis from 2006 to 2010. Medications were examined in terms of total number of prescription claims, proportion of patients exposed, and DDI potential with the prototypical CYP3A direct-acting antiviral agents boceprevir and telaprevir, for which data were available.
Patient comorbidity burden was high and increased over the study period. Medication use was investigated in 53 461 patients with chronic HCV. Twenty-one (53%) of the top 40 most utilized medications were classified as having interaction potential, with 62% of patients receiving at least one of the top 22 interacting medications by exposure. Of these, 59 and 41% were listed in a common DDI resource but not in medication-prescribing information, 77 and 77% had not been investigated in DDI studies, 41 and 36% did not have clear recommendations for DDI management, and only 14 and 23% carried a recommendation to avoid coadministration for boceprevir and telaprevir, respectively.
Practitioners may expect a medication with CYP3A DDI potential in two-thirds of patients with HCV and may expect almost one-half of the most frequently used medications to have CYP3A DDI potential. However, DDI potential may not be reflected in prescribing information.
随着直接作用抗病毒药物的出现，接受慢性丙型肝炎病毒（HCV）感染治疗的患者现在存在显著的药物相互作用（DDI）可能性。然而，对于HCV感染患者使用可能与新型HCV治疗药物相互作用的药物的频率知之甚少，尤其是那些具有细胞色素P450 3A（CYP3A）DDI可能性的药物。
利用一个大型美国商业保险数据库，对2006年至2010年诊断为慢性HCV的成年患者的用药情况和合并症负担进行了研究。从处方申请总数、暴露患者比例以及与典型的CYP3A直接作用抗病毒药物博赛匹韦和特拉匹韦的DDI可能性方面对药物进行了研究，可获得相关数据。
患者的合并症负担较高，且在研究期间有所增加。对53461例慢性HCV患者的用药情况进行了调查。40种最常用药物中有21种（53%）被归类为具有相互作用可能性，62% 的患者通过暴露接受了前22种相互作用药物中的至少一种。其中，59% 和41% 列在常见的DDI资源中，但未列在药物处方信息中，77% 和77% 未在DDI研究中进行过调查，41% 和36% 没有关于DDI管理的明确建议，只有14% 和23% 分别有建议避免与博赛匹韦和特拉匹韦合用。
从业者可能预计三分之二的HCV患者使用的药物具有CYP3A DDI可能性，并且可能预计近一半最常用药物具有CYP3A DDI可能性。然而，DDI可能性可能未在处方信息中体现。
