Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.
Gut Liver. 2021 Mar 15;15(2):295-306. doi: 10.5009/gnl19387.
BACKGROUND/AIMS: Extrahepatic comorbidities and comedication are important to consider in the treatment of chronic hepatitis C (CHC) patients with direct-acting antivirals (DAAs) due to the risk of drug-drug interaction (DDI) and the effect of comorbidities on clinical outcomes. This study aimed to investigate the detailed profiles of comorbidities and comedication among Korean CHC patients.
All adult patients (≥18 years old) with a primary diagnostic code of CHC in 2013 were selected from the National Health Insurance claims database. For each patient, all ICD-10 codes listed as primary or secondary diagnoses and all prescribed medications were collected.
Among 47,104 CHC patients (median age, 57 years; male, 49.3%), 84.8% had at least one comorbidity for a mean number of 2.4, which increased with age. The most prevalent comorbidities were hypertension, esophagitis, dyslipidemia, diabetes mellitus, and peptic ulcer. Overall, 96.8% of the patients took at least one prescribed medication, with a mean of 8.1 medications/ year, and the three most common drug types were analgesics, gastrointestinal agents, and antibacterials. Use of at least one drug with a DDI risk category of "contraindicated medication" or "required dose-reduction/additional monitoring" was observed in 97% of the overall patients. The proportion of prescribed medications that were contraindicated with DAAs varied from 2.0% to 38.9% depending on the hepatitis C virus regimen.
The majority of CHC patients had comorbidities; almost all patients took multiple prescribed medications, the number of which increased with age, and significant DDI risk was present in 97% of this Korean patient cohort. Comorbidities and comedication profiles should be considered during DAA therapy.
背景/目的：由于药物相互作用（DDI）的风险以及合并症对临床结局的影响，对于接受直接作用抗病毒药物（DAA）治疗的慢性丙型肝炎（CHC）患者，需要考虑肝外合并症和合并用药。本研究旨在调查韩国 CHC 患者的合并症和合并用药的详细情况。
从国家健康保险索赔数据库中选择 2013 年有原发性 CHC 诊断代码的所有成年患者（≥18 岁）。对于每位患者，均收集所有 ICD-10 编码作为主要或次要诊断以及所有规定的药物。
在 47104 例 CHC 患者中（中位年龄 57 岁；男性占 49.3％），84.8％的患者至少有一种合并症，平均合并症数量为 2.4 种，且随着年龄的增长而增加。最常见的合并症是高血压、食管炎、血脂异常、糖尿病和消化性溃疡。总体而言，96.8％的患者至少服用一种规定的药物，每年平均 8.1 种药物，三种最常见的药物类型是镇痛药、胃肠药和抗菌药。在所有患者中，有 97％的患者至少使用一种具有“禁忌药物”或“需要减少剂量/增加监测”的 DDI 风险类别的药物。根据丙型肝炎病毒方案的不同，规定的与 DAA 相互禁忌的药物比例从 2.0％到 38.9％不等。
大多数 CHC 患者有合并症；几乎所有患者都服用多种规定的药物，且随着年龄的增长而增加，在这个韩国患者队列中，有 97％的患者存在明显的 DDI 风险。在 DAA 治疗期间，应考虑合并症和合并用药情况。
