Methods: Pts were considered for inclusion if they were >18 years old, HCV mono-infected, managed for HCV treatment through the Northwestern Medicine Specialty Pharmacy, and completed HCV therapy. Treatment failures (TFs) were matched 1:4 with treatment successes (TSs) based on HCV regimen and pre/post transplant status. Pt demographic, HCV, and pharmacist intervention variables were assessed. Stepwise multivariate regression was performed to assess predictors of HCV TF.
Results: 19 TFs were matched with 76 TSs. All pts received baseline pharmacist counseling and follow-up phone calls to identify treatment issues. Sofosbuvir/simeprevir (n=64) and sofosbuvir/ribavirin (n=31) were used for treatment. There were more male pts (n=16, 84% vs n=44, 58%, p=0.04) and pts with diabetes (n=13, 69% vs n=24, 32%, p<0.01) in the TFs than TSs group. Pts with a lower education level (grade school vs college or above) were more likely to fail (p<0.01) as were pts that were unemployed (n=18, 95% vs n=56, 74%, p=0.03). Experiencing an adverse effect (p=0.02) and pt reported missed doses >1 (p<0.01) were also associated with TF. More pts in the TSs group had >1 outpatient clinic visit with a pharmacist than the TFs group (n=58, 76% vs n=9, 47%, p=0.01). In a multivariate analysis, the comorbidity diabetes remained a significant predictor of TF (OR 7.2, 95% CI 1.7-30.8).
Conclusion: Pharmacists may be able to target resources to pts with these TF risk factors for intensive intervention. Increased pharmacist contact was associated with treatment success. Further study is needed to elucidate the impact of education level and diabetes on successful HCV treatment.
M. Postelnick, None
H. Brooks, Abbvie: Employee , Salary
M. Mclaughlin, BioCryst Pharmaceuticals: Served on Advisory Board , Consulting fee