Comorbidities and Prescribed Medications in Korean Patients with Chronic Hepatitis C: A Nationwide, Population-Based Study

Abstract

contributed equally to this work as first authors. Background/Aims: Extrahepatic comorbidities and comedication are important to consider in the treatment of chronic hepatitis C (CHC) patients with direct-acting antivirals (DAAs) due to the risk of drug-drug interaction (DDI) and the effect of comorbidities on clinical outcomes. This study aimed to investigate the detailed profiles of comorbidities and comedication among Korean CHC patients. Methods: All adult patients (≥18 years old) with a primary diagnostic code of CHC in 2013 were selected from the National Health Insurance claims database. For each patient, all ICD-10 codes listed as primary or secondary diagnoses and all prescribed medications were collected. Results: Among 47,104 CHC patients (median age, 57 years; male, 49.3%), 84.8% had at least one comorbidity for a mean number of 2.4, which increased with age. The most prevalent comorbidities were hypertension, esophagitis, dyslipidemia, diabetes mellitus, and peptic ulcer. Overall, 96.8% of the patients took at least one prescribed medication, with a mean of 8.1 medications/ year, and the three most common drug types were analgesics, gastrointestinal agents, and antibacterials. Use of at least one drug with a DDI risk category of "contraindicated medication" or "required dose-reduction/additional monitoring" was observed in 97% of the overall patients. The proportion of prescribed medications that were contraindicated with DAAs varied from 2.0% to 38.9% depending on the hepatitis C virus regimen. Conclusions: The majority of CHC patients had comorbidities; almost all patients took multiple prescribed medications, the number of which increased with age, and significant DDI risk was present in 97% of this Korean patient cohort. Comorbidities and comedication profiles should be considered during DAA therapy.

Comorbidities and the use of comedications among patients with chronic hepatitis C in Korea: A nationwide cross-sectional study

“…In this study, nearly all identified CHC patients had comorbidities (97.5%) and comedications (97.5%). The previous study of CHC patients from another national data base of 2013 showed that 84.8% of CHC patients had comorbidities and 96.8% of patients with comedications [8]. Since this study implemented the similar inclusion and exclusion criteria for patient selection from the previous study [8], as well as methods of counting comorbidity and comedications, one can assume that the proportions of CHC patients with comorbidities and comedications have relatively increased.…”

“…The previous study of CHC patients from another national data base of 2013 showed that 84.8% of CHC patients had comorbidities and 96.8% of patients with comedications [8]. Since this study implemented the similar inclusion and exclusion criteria for patient selection from the previous study [8], as well as methods of counting comorbidity and comedications, one can assume that the proportions of CHC patients with comorbidities and comedications have relatively increased. This could be associated with the high proportion of elderly patients aged ≥ 55 years recorded in this study (n = 34,285), wherein the elderly patients would have higher underlying comorbidities than younger patients [18].…”

“…Considering the nature of the claims data and the National health care system in Korea, this HIRA data represents characteristics of the HCV patients diagnosed in Korea. Since the previous research from Chung et al [8], utilized the 2013 NHIS (National Health Insurance System) data and the HIRA data was used to identify patients recorded in 2018, we could not have a direct comparison between the two data sets. Although we were not able to make a direct comparison of the 2013 NHIS data to the 2018 HIRA data, the HIRA data well represents the prescription pattern nationwide as we investigated the changing trends of CHC patients in Korea.…”

“…While comparing with the western countries where most of the patients are young intravenous drug users [3], the prevalence of CHC increases with age in Korea with procedures-based transmission such as acupuncture, tattooing, and piercing as the major root of transmission [6,7]. One study using the Korean National Health Insurance (NHI) claims database of 2013 has shown that 84.8% of patients with CHC had at least one comorbidity and 96.8% of the patients took at least one prescribed medication [8]. With such patient demographics, a thorough review of comorbidity and comedication is required before HCV treatment to prevent any drug-drug interactions (DDIs) [8].…”

“…One study using the Korean National Health Insurance (NHI) claims database of 2013 has shown that 84.8% of patients with CHC had at least one comorbidity and 96.8% of the patients took at least one prescribed medication [8]. With such patient demographics, a thorough review of comorbidity and comedication is required before HCV treatment to prevent any drug-drug interactions (DDIs) [8]. This is further reinforced by the International guidelines including the American Association for the Study of Liver Diseases, European Association for the Study of the Liver, and Asian Pacific Association for the Study of the Liver recommended thorough review of medications in all HCV patients to consider DDI risk prior to starting DAA therapy or other medications during treatment in all patients undergoing DAAs intervention [9][10][11].…”