Effect on the adherence to concomitant medications after initiation of treatment with direct-acting antiviral agents against hepatitis C virus |
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| Affiliation: | 1. Valme Hospital (Pharmacy Department), Seville, Spain;2. Infectious Diseases and Microbiology Unit, Valme Hospital, Seville, Spain;1. Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Medicina Digestiva, Hospital Universitari i Politècnic La Fe, Valencia, Spain;2. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain;3. Instituto de Investigación Sanitaria La Fe, Valencia, Spain;1. Unidad de Endoscopia, Servicio de Gastroenterología, ICMDiM, IDIBAPS, CIBEREHD, Hospital Clínic, Universitat de Barcelona, Barcelona, España;2. Servicio Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, España;3. Unidad de Endoscopia, Departamento de Gastroenterología, Centro Médico Teknon, Barcelona, España;4. Servicio de Cirugía Gastrointestinal, ICMDiM, Hospital Clínic, Universitat de Barcelona, Barcelona, España;5. Servicio de Cirugía Gastrointestinal, ICMDiM, IDIBAPS, CIBEREHD, AIS Channel, Hospital Clínic, Universitat de Barcelona, Barcelona, España;1. Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Tenerife, Spain;2. Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain;3. Servicio de Aparato Digestivo, Hospital de Galdakao, Galdakao, Spain;4. Servicio de Radiología, Hospital Universitario de Canarias, Tenerife, Spain;5. Servicio de Radiología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz De Tenerife, Spain;6. Osatek, Hospital de Galdakao, Galdakao, Spain;1. Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol de Badalona, Barcelona, Spain;2. Endoscopy Unit, Teknon Medical Center, Barcelona, Spain;3. Endoscopy Unit, Department of Digestive Diseases, Hospital Del Mar, Barcelona, Spain;4. IMIM, Hospital del Mar Medical Research Institute, Spain;5. Department of Medicine, Universitat Autònoma de Barcelona, Spain;6. Endoscopy Unit, Department of Digestive Diseases, Hospital Clinic, Barcelona, Spain;7. Endoscopy Unit, Department of Digestive Diseases, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain;8. Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain;9. Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrassa, Catalonia, Spain;10. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain;1. Servicio de Microbiología, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain;2. Grupo de Estudio de Hepatitis Virales GEHEP-SEIMC;3. Servicio de Microbiología, Complexo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago IDIS, Santiago de Compostela, Spain;4. Servicio Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, IDIVAL, UNICAN, Santander, Spain;5. Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Sevilla, Spain |
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| Abstract: | IntroductionMany patients with hepatitis C virus (HCV) have associated comorbidities that require complex treatments. We sought to determine the impact of treatment with direct-acting antiviral agents (DAAs) for HCV on adherence to prescribed concomitant medications for associated comorbidities and to identify predictors of non-adherence to comedications.Patients and methodsHCV-infected patients treated with DAAs in a Spanish hospital between January 2015 and December 2016 and followed-up by the pharmacy unit were included in the study. Adherence to concomitant comedication prescribed before and during HCV therapy with DAAs was compared to adherence during the same number of weeks before DAA initiation. Demographic, clinical and pharmacotherapy variables were analyzed to determine factors associated with non-adherence. A multivariate regression model was created for prediction of non-adherence to concomitant medication.ResultsData from 214 patients using prescribed concomitant therapies were analyzed. Significant reduction on adherence to comedications was observed after initiation of DAA treatment compared with a similar period before therapy initiation (29.9% vs. 36.9%, p = 0.032). The univariate analysis showed that polypharmacy and presence of vascular disease were associated negatively with adherence to concomitant medications (87.8%, p = 0.006 and 84.7%, p < 0.001, respectively). Multivariate analysis indicated that HIV/HBV coinfection was associated with adherence (OR 0.19; 95% CI 0.09–0.39), while polypharmacy was a predictor for non-adherence (OR 4.54; 95% CI 1.48–13.92).DiscussionAdherence to concomitant medications decreases in HCV-infected patients when DAA therapy is initiated. Polypharmacy is a predictor for non-adherence, while HIV/HBV coinfection reduce non-adherence rates. Polymedicated patients on DAAs might benefit from close follow-up and educational programmes to improve their adherence. |
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| Keywords: | Hepatitis C virus Direct-acting antiviral Adherence Concomitant medication Polypharmacy Virus de la hepatitis C Antivirales de acción directa Adherencia Medicación concomitante Polifarmacia |
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