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Is response-guided therapy being applied in the clinical setting? The hepatitis C example
Jennifer B Harris1, Melea A Ward2, Phil Schwab3
1Clinical Pharmacist, Humana Inc, Louisville, KY.
American Health & Drug Benefits
|May 13, 2015
Summary
Response-guided therapy (RGT) for hepatitis C virus (HCV) infection showed suboptimal adherence. Less than 33% of patients followed HCV RNA monitoring, and under 50% adhered to futility rules, impacting patient care.
Area of Science:
- Pharmacoeconomics
- Hepatology
- Clinical Pharmacy Practice
Background:
- Response-guided therapy (RGT) tailors treatment based on individual patient response.
- This approach is used for chronic hepatitis C virus (HCV) infection with triple therapy (boceprevir/telaprevir + interferon + ribavirin).
- RGT is expanding to other diseases like breast cancer and acute myeloid leukemia.
Purpose of the Study:
- To measure adherence to RGT guidelines for boceprevir and telaprevir in HCV treatment.
- To assess adherence to treatment futility rules based on drug labeling.
- To evaluate the optimization of RGT benefits in clinical practice.
Main Methods:
- Retrospective observational cohort study using the Humana research database.
- Included patients aged 18-90 with commercial or Medicare Advantage coverage receiving boceprevir or telaprevir for HCV.
- Analyzed adherence to HCV RNA monitoring and treatment futility rules over a 32-week follow-up period.
Main Results:
- Adherence to HCV RNA monitoring was low: 29.2% for boceprevir and 32.2% for telaprevir.
- Monitoring adherence decreased over time; adherence was highest at the first interval.
- Approximately 15% of eligible patients met futility rules, but only 55% discontinued therapy.
Conclusions:
- RGT implementation was suboptimal in chronic HCV patients.
- Low adherence to monitoring and futility rules may hinder RGT's benefits.
- Managed care pharmacists should develop strategies to improve RGT adoption for better patient care and cost reduction.
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