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Published on: April 9, 2014
A survey of hepatitis C treatment clinical practice patterns using the newly approved protease inhibitors
Emerson Y Chen1, William M Lee, Linda S Hynan
1*Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center and Parkland Health and Hospital System Departments of †Clinical Sciences ‡Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX.
Insights
Physicians increasingly use direct-acting antivirals (DAAs) for hepatitis C virus (HCV) treatment, including off-label for HIV co-infection and post-transplant patients. Academic affiliation influences these DAA prescribing patterns.
Area of Science:
- Hepatology
- Infectious Diseases
- Clinical Practice
Background:
- Hepatitis C virus (HCV) treatment paradigms have shifted significantly with the advent of direct-acting antivirals (DAAs).
- Current HCV treatment practices and physician prescribing behaviors following DAA introduction remain under-assessed.
- DAAs are now the standard of care for the majority of patients with HCV genotype 1.
Purpose of the Study:
- To delineate contemporary HCV treatment strategies employed by US physicians.
- To ascertain physician-specific factors correlated with the utilization of first-generation DAAs.
- To analyze DAA prescribing patterns across diverse clinical scenarios, including treatment-naive, treatment-experienced, and special populations.
Main Methods:
- A nationally representative sample of physicians treating HCV patients with DAAs was surveyed online.
- Stepwise multivariate logistic regression analysis identified physician characteristics associated with DAA use.
- Four distinct clinical vignettes were used to assess treatment decisions: early fibrosis, prior null response, HIV co-infection, and post-liver transplantation.
Main Results:
- Half of surveyed providers recommended DAAs for treatment-naive patients with early fibrosis, while a similar proportion considered awaiting newer therapies.
- For patients with prior null response and significant fibrosis, 74% would opt for DAA retreatment, versus 26% who would wait.
- Off-label DAA use was common: 69% for HIV co-infected patients and 48% for post-transplant patients. Academic affiliation correlated with increased off-label DAA recommendations.
Conclusions:
- Many physicians are recommending current DAAs for treatment-naive patients with early-stage fibrosis, despite upcoming advanced therapies.
- DAAs are frequently prescribed off-label for complex cases, including post-liver transplant recipients and individuals with HIV co-infection.
- Physician characteristics, such as academic affiliation, are associated with specific DAA prescribing behaviors, particularly in off-label settings.
Goals:
To describe current hepatitis C virus (HCV) treatment practices in the United States and identify physician characteristics associated with the use of first generation direct-acting antivirals (DAAs).
Background:
HCV treatment practice patterns have not been assessed after the introduction of DAA, which are now considered standard of care for most HCV genotype 1 patients.
Study:
We sampled nationally representative physicians treating HCV patients with DAAs through a web-based survey. Stepwise multivariate logistic regression was performed to identify physician characteristics associated with the use of DAAs in 4 clinical vignettes (early stage fibrosis, prior null response, human immunodeficiency virus (HIV) co-infection, and post-liver transplantation).
Results:
Of 1658 deliverable emails, 337 (20.3%) clinicians responded. Fifty percent of providers recommended DAA therapy for treatment-naive patients with early stage fibrosis, whereas 49% of providers would await new therapies. For prior null responders with significant fibrosis, 74% would attempt retreatment using DAAs and 26% would await new therapies. Off-label use of DAAs was recommended by 69% of providers for patients with HIV infection and 48% of providers for post-liver transplant patients. Academic affiliation was significantly associated with higher rates of off-label use in both HIV and post-liver transplant patients.
Conclusions:
Despite more potent and less toxic therapies on the horizon, many physicians recommended DAAs in treatment-naive patients with early stage fibrosis. Providers also frequently recommended DAAs for off-label uses, such as treating post-liver transplant patients and those coinfected with HIV.
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