Ottman Andreina A, Townsend Mary L, Hashem Mohamed G, DiMondi Vincent P, Britt Rachel B
1 Durham Veterans Affairs Health Care System, Durham, NC, USA.
2 Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
Ann Pharmacother. 2018 Aug;52(8):763-768. doi: 10.1177/1060028018766507. Epub 2018 Mar 26.
Many direct-acting antivirals (DAAs) have drug-drug interactions (DDIs) with the potential to affect efficacy and safety.
To describe the incidence and severity of DDIs with DAAs identified by the hepatitis C virus (HCV) clinical pharmacist within a Veterans Affairs health care system.
This single-center, retrospective cohort study evaluated patients with HCV treated with DAA therapy. Primary end points included the total number of identified DDIs, percentage of patients with at least 1 DDI, mean number of DDIs per patient, and the number of DDIs by severity category. Additional end points included characterization of interacting drugs, clinical consequence of interaction, intervention recommended, acceptance rate of actionable recommendations, and achievement of sustained virological response 12 weeks after treatment (SVR12).
A total of 300 patients were included. There were 554 identified DDIs, and 80.3% of patients had at least 1 DDI, with an average of 1.85 DDIs per patient; 76% of the DDIs identified were categorized as either a potentially clinically significant or critical interaction. The most common DDIs involved acid suppression agents (20%). Patient monitoring was the most commonly recommended intervention (59%), followed by dose modification of the interacting medication (30%). There was no difference in SVR12 between patients with at least 1 DDI compared with those with no DDIs (94.8% vs 95.8%; P = 0.73). There were a total of 227 actionable recommendations, with an acceptance rate of 84.1%.
This study suggests that DDIs are prevalent among patients treated with DAAs for HCV. A HCV clinical pharmacist can help optimize patient care by identifying DDIs and recommending interventions to providers.
许多直接作用抗病毒药物（DAA）存在药物相互作用（DDI），可能影响疗效和安全性。
描述退伍军人事务医疗系统中丙型肝炎病毒（HCV）临床药师识别出的DAA相关DDI的发生率和严重程度。
这项单中心回顾性队列研究评估了接受DAA治疗的HCV患者。主要终点包括识别出的DDI总数、至少有1次DDI的患者百分比、每位患者的平均DDI数以及按严重程度分类的DDI数量。其他终点包括相互作用药物的特征、相互作用的临床后果、推荐的干预措施、可行建议的接受率以及治疗12周后持续病毒学应答（SVR12）的实现情况。
共纳入300例患者。共识别出554次DDI，80.3%的患者至少有1次DDI，每位患者平均有1.85次DDI；识别出的DDI中有76%被归类为潜在临床显著或严重相互作用。最常见的DDI涉及抑酸剂（20%）。患者监测是最常推荐的干预措施（59%），其次是相互作用药物的剂量调整（30%）。至少有1次DDI的患者与无DDI的患者在SVR12方面无差异（94.8%对95.8%；P = 0.73）。共有227条可行建议，接受率为84.1%。
本研究表明，在接受DAA治疗的HCV患者中，DDI很常见。HCV临床药师可通过识别DDI并向医疗服务提供者推荐干预措施来帮助优化患者护理。
