A Survey of Hepatitis C Treatment Clinical Practice Patterns Using the Newly Approved Protease Inhibitors

Abstract

Goals To describe current HCV treatment practices in the United States and identify physician characteristics associated with the use of first generation DAAs. Background Hepatitis C virus (HCV) treatment practice patterns have not been assessed after the introduction of direct-acting antivirals (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 four clinical vignettes (early stage fibrosis, prior null response, 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-naïve patients with early stage fibrosis, whereas 49% of providers would await new therapies. For prior null responders with significant fibrosis, 74% would attempt re-treatment 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 naïve patients with early stage fibrosis. Providers also frequently recommended DAAs for off-label uses, such as treating post-liver transplant patients and those co-infected with HIV.

Changes in Utilization and Discard of Hepatitis C–Infected Donor Livers in the Recent Era

“…Although the use of these first DAAs was significantly limited by serious toxicities and drug-drug interactions with relatively poor outcomes among transplant patients, their introduction may have brought optimism to the field about agents in the pipeline or may have reflected a lag between the excitement about the first DAAs and the reporting of adverse outcomes. A survey of transplant physicians found that although 48% of providers were using these first-generation DAAs (protease inhibitors), 22% were going to wait for improved therapies before treating posttransplant, indicating awareness of future therapies and increasing comfort in use of DAAs in HCV-positive liver transplant recipients (24). Long-term shifts in access to liver transplantation among all deceased donor liver transplantation (DDLT) recipients could also partially explain the increase we observed among HCV-positive recipients if declines in access have been leading to increased use of these marginal organs.…”

Faculty Opinions recommendation of Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era.

“…While the use of these first DAAs was significantly limited by serious toxicities and drug-druginteractions with relatively poor outcomes among transplant patients, their introduction may have brought optimism to the field about agents in the pipeline, or may have reflected a lag between the excitement about the first DAAs and the reporting of adverse outcomes. A survey of transplant physicians found that while 48% of providers were using these first generation DAAs (protease inhibitors), 22% were going to wait for improved therapies before treating post-transplant, indicating awareness of future therapies and increasing comfort in use of DAAs in HCV+ liver transplant recipients (24). Long term shifts in access to liver transplantation among all DDLT recipients could also partially explain the increase we observed among HCV+ recipients if declines in access have been leading to increased use of these marginal organs.…”