studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 531A
646
Significant non–adherence to DAA HCV therapy in
decompensated patients - a tertiary hepatology centre
assessment
Aisling B. Considine 1,2 , Suman Verma 3 , Kath Oakes 3 , Kate E.
Childs 3 , Sarah Knighton 1,2 , Andrew Ayers 3 , Abid Suddle 3 , Kosh
Agarwal 3 ; 1 Pharmacy, Kings College Hospital, London, United
Kingdom; 2 Kings College London, Institute of Pharmaceutical Sciences,
London, United Kingdom; 3 Kings College Hospital, Institute
of Liver Studies, London, United Kingdom
Background: The advent of directly acting anti-virals (DAA) has
led to simplified HCV regimens with increased efficacy rates
and better tolerability. The high adherence seen in clinical
trials may not translate to real life populations. Optimal adherence
is critical to protect patients from treatment failure and
resistance. Aim: To identify potential factors which may contribute
to sub-optimal adherence in a population with decompensated
cirrhosis. Methods: HCV patients eligible for access
to a 12 week treatment regimen under a UK NHSE mandated
access scheme were consented to complete a baseline questionnaire
capturing data on sociodemographics, clinical status
and perceptions of illness.Adherence assessments at treatment
weeks 4, 8 and 12 with pill counts and a Morisky Medication
Adherence Scale were undertaken. Suboptimal adherence
(SA) was defined as any report or pill count which indicated
a delayed (>2hrs) or missed dose of anti-viral. Descriptive
statistic and multivariate regression methods were utilised for
analysis. Results: 80% (n=47) of the cohort had reached SVR
12 and are included in the adherence analysis.85% received
sofosbuvir/ledipasvir and 15% sofosbuvir with daclatasvir. All
patients received ribavirin and had been attending specialist
hepatology services for >12 months.43% (n=20) of patients
demonstrated SA during their treatment. Multivariate analysis
demonstrated that any non-attendance during treatment
and a ‘limited support network’ predicted higher rates of SA
(p3 medications
(vs 74% in adherent group). The average MELD score was
15 in the SA group (vs 13 in adherent group). 80% of SA
was associated with symptoms secondary to disease stage not
reflected by the MELD. SA secondary to side effects of therapy
was not identified. 85% of the SA group achieved SVR12.Failure
to achieve SVR was seen in those with SA adherence at all
assessment points (weeks 4, 8 and 12). Conclusions: Our initial
results demonstrate that despite an intensive adherence focused
multi-disciplinary approach, SA occurs in decompensated HCV
cirrhotic patients. Acceptable SVR rates were achieved in this
population. Further research is warranted to develop strategies
which maximise adherence in all HCV populations.
Disclosures:
Kosh Agarwal - Advisory Committees or Review Panels: Gilead, BMS, Novartis,
Janssen, AbbVie, Gilead; Consulting: MSD, Janssen; Grant/Research Support:
Roche, Gilead, BMS, BMS; Speaking and Teaching: Astellas
The following authors have nothing to disclose: Aisling B. Considine, Suman
Verma, Kath Oakes, Kate E. Childs, Sarah Knighton, Andrew Ayers, Abid Suddle
647
Hepatology nursing in Canada: Current practices and
future challenges
Colina Yim 1 , Cheryl Dale 2 , Geri Hirsch 3 , Jo-Ann E. Ford 4 , Carolyn
Klassen 4 ; 1 University Health Network, Toronto, ON, Canada;
2 London Health Sciences Centre, London, ON, Canada; 3 Halifax
Capital District Health Authority, Halifax, NS, Canada; 4 Vancouver
General Hospital, Vancouver, BC, Canada
Background: Hepatitis C treatment landscape is changing.
The rapid therapeutic advancements may impact the roles and
responsibilities of some of the hepatology nurses whose practice
focused solely on hepatitis C. This study aims to describe
the current practices of hepatology nurses in Canada and
to gain insights into nurses’ perceptions and concerns about
their future roles and values. Methods: An 18-item survey was
designed. Survey was sent in November 2014 to all active
members of the Canadian Association of Hepatology Nurses
(CAHN) via email for their voluntary participation. A second
email was sent 8 weeks later as a reminder to complete survey.
Demographics collected include age, length of practice,
practice settings and focuses. CAHN Members were asked to
rate their levels of concerns in regards to job security, sustainability
of current positions, change of role and the future of
hepatology nursing. Results: Of a total of 136 active CAHN
members, 94 (69%) completed the survey. Eighty-one percent
were employed full time, 78% age > 40 years, 64% have at
least 6 years or more work experience in hepatology. Hepatitis
C treatment was the sole practice focus in 52% while 38% of
them managed more than 50 hepatitis C patients on treatment
in last 6 months. A majority of CAHN members (78%) work
in academic institutions and community settings. Salary support
varies with 35% being paid from industry grants and the
remainder either by government (health authority, provinces,
academic centres and community agencies) or by research
grants. Up to 85% expressed satisfaction with their current
positions and the support they received from their physician
partners but at least 60% are concerned about their job security,
job description change and current position sustainability.
A lack of funding for hepatology nurse positions remain the
major challenge, 69% of members predict a positive hepatology
nursing future. Conclusions: Hepatology nurses in Canada
are experienced professionals in the field. A majority have a
focused practice on hepatitis C treatment management. We
are satisfied with our current roles and responsibilities and
feel most supported by our physician colleagues. Hepatology
nurses acknowledge challenges exist for role sustainability but
remain optimistic about our values in future.
Disclosures:
Colina Yim - Advisory Committees or Review Panels: Janssen; Consulting: Gilead;
Speaking and Teaching: Abbvie
Jo-Ann E. Ford - Advisory Committees or Review Panels: Gilead, Roche, Janssen,
Merck Canada, Vertex; Speaking and Teaching: Gilead, Roche, Janssen, Merck
Canada, Vertex
The following authors have nothing to disclose: Cheryl Dale, Geri Hirsch, Carolyn
Klassen
648
Pharmacists mitigate effect of simeprevir on blood pressure
in patients with hepatitis C infection receiving concurrent
calcium channel blocker therapy
Heather Johnson 1,2 , Emily Graham 2 , Michael A. Dunn 1 , Kapil B.
Chopra 1 ; 1 University of Pittsburgh, PIttsburgh, PA; 2 UPMC Presbyterian,
Pittsburgh, PA
Simeprevir (SMV) an NS3/4A inhibitor for the treatment of
Hepatitis C infection (HCV), has a number of drug-drug inter-