Drug–drug interactions between direct-acting antivirals and co-medications: a territory-wide cohort study
verfasst von:
Vicki Wing-Ki Hui, Christopher Langjun Au, Amy Shuk Man Lam, Terry Cheuk-Fung Yip, Yee-Kit Tse, Jimmy Che-To Lai, Henry Lik-Yuen Chan, Vincent Wai-Sun Wong, Grace Lai-Hung Wong
The increasing number of direct-acting antiviral (DAA) regimens along with limited number of subjects and co-medications involved in clinical trials results in drug–drug interactions (DDIs) with DAAs is to be determined. We aimed to examine the prevalence and degree of DDIs between DAAs and other co-medications in a territory-wide cohort of chronic hepatitis C virus (HCV) patients.
Methods
DDIs were assigned to three risk categories: Category 1—no clinically significant DDI; category 2—potential clinically significant interaction (monitoring and caution required); category 3—contraindicated (should not be co-administered).
Results
Of 2981 patients (mean age 59.3 ± 12.3 years; male 60.6%), 810 (48.8%) had genotype 1 and 552 (33.2%) genotype 6 HCV among the 1661 patients with HCV genotype tested; 769 (25.8%) received sofosbuvir/velpatasvir, 510 (17.1%) sofosbuvir/ledipasvir, and 865 (29.0%) glecaprevir/pibrentasvir. More than one-fourth (26.3%) of the patients have polypharmacy (≥ 3 co-medications) in all patients, 27.0% in patients received sofosbuvir/velpatasvir, 25.1% in elbasvir/grazoprevir, and 21.2% in glecaprevir/pibrentasvir. 2037 (68.3%) patient experienced DDI (Category 2: 53.1%; Category 3: 15.2%). The commonest drugs leading to DDIs were calcium channel blockers (31.5%) and proton pump inhibitors (23.0%) in category 2; statins (10.2%), antiplatelet/anticoagulants (3.0%) and antipsychotics (2.9%) in category 3. Changing medication was the most common response from physicians in both category 2 and 3 DDIs.
Conclusion
The commonest co-medications leading to contraindication during DAA treatment were statins and antipsychotics. Category 2 and 3 DDIs are often managed by appropriate dose adjustments or temporary discontinuation of relevant co-medications. Careful assessment for potential DDI before DAA use is mandatory to avoid potential harmful effects.
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Drug–drug interactions between direct-acting antivirals and co-medications: a territory-wide cohort study
verfasst von
Vicki Wing-Ki Hui Christopher Langjun Au Amy Shuk Man Lam Terry Cheuk-Fung Yip Yee-Kit Tse Jimmy Che-To Lai Henry Lik-Yuen Chan Vincent Wai-Sun Wong Grace Lai-Hung Wong
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