studies

772A AASLD ABSTRACTS HEPATOLOGY, October, 2015
1140
Co-morbidities and co-medications of patients with
chronic hepatitis C (CHC) under specialist care in the UK
- Challenges for scaling up HCV treatment?
Benjamin E. Hudson 3,8 , William Irving 4,5 , Stephen T. Barclay 1 ,
Fiona Marra 2,6 , Alex J. Walker 7 ; 1 Walton Liver Clinic, Glasgow,
United Kingdom; 2 NHS Greater Glasgow and Clyde, Glasgow,
United Kingdom; 3 HCV Research UK, Nottingham, United Kingdom;
4 NIHR Nottingham Digestive Diseases Biomedical Research
Unit, Nottingham, United Kingdom; 5 School of Life Sciences, University
of Nottingham, Nottingham, United Kingdom; 6 University of
Liverpool, Liverpool, United Kingdom; 7 University of Nottingham,
School of Life Sciences, Nottingham, United Kingdom; 8 Cambridge
University Hospitals NHS trust, Cambridge, United Kingdom
Introduction Most patients with CHC can benefit from direct
acting antiviral (DAA). Alongside specific CHC disease indicators,
physical/psychiatric comorbidities, lifestyle factors
and related co-medications with drug-drug interaction (DDI)
potential will inform appropriate CHC treatment selection. We
describe demographics, comorbidities and common co-medications
of CHC patients currently under specialist care in the
UK. Methods Retrospective analysis of routinely collected data
of CHC patients from 59 UK specialist centres enrolled with
the National HCV Research UK Biobank between 03/2012-
10/2014. Results 6,278 patients were analysed. Median age
52 years (IQR 43-59), 70.4% male, 84.7% white. Genotype
1: 50%, 2: 4.0%, 3: 33.7%, 4: 3.6%, 5/6: 0.3%. Cirrhotic:
23.6% (age >60’s 36.6%). Acquisition mode: injection drug
use (IDU) 59.2%, blood products 11.3%, non-UK born 9.4%,
other 20.1%. Subgroup analysis for IDU acquisition and age
was performed. Social history (Hx): previous/current heavy
alcohol use: overall 38.3% (IDU 50.1%), current cannabis use:
24.6% (IDU 35.2%). Comorbidities: Hx of depression: 45.4%
(IDU 57.6%), Hx of attempted suicide or inpatient treatment
for depression: 19.4% (IDU 27.3%). HIV co-infection 5.0%
(IDU: 4.5%). Prevalence of diabetes, cancer and renal dialysis
correlated with age (Diabetes: overall 11.3%, >60s 22.9%,
Cancer: 8.1% vs 18.1%, Dialysis: 1.3% vs 2.2%). Most common
co-medications with DDI potential were psychotropic with
38.6% (IDU 53.3%) on either antidepressant (22.9%), opioid
replacement (21.2%) or hypnotic (10.4%) (includes polypharmacy).
Prescriptions of antidiabetics, statins and immunosuppressants
rose sharply with age (60’s 31.7%).
Conclusions We found high levels of co-morbidity, ongoing
substance abuse and co-medication with DDI potential in
CHC populations under specialist care in the UK. Age-related
increasing levels of advanced liver disease, comorbidities and
polypharmacy may further increase the challenges in managing
this patient group. CHC treaters need to be aware of DDI
potential when choosing appropriate CHC treatments.
*antidepressants, opioid replacement, hypnotics;** Antiretrovirals;**not
specified
Disclosures:
William Irving - Advisory Committees or Review Panels: Novartis, MSD, Janssen
Cilag, Bristol Myers Squibb; Grant/Research Support: GSK, Pfizer, Janssen
Cilag, Gilead Sciences; Speaking and Teaching: Janssen Cilag, Roche
Stephen T. Barclay - Advisory Committees or Review Panels: Gilead, Janssen,
MSD, Abbvie, BMS; Speaking and Teaching: Gilead, Janssen
Fiona Marra - Advisory Committees or Review Panels: Gilead, AbbVie, Merck;
Consulting: Gilead; Speaking and Teaching: Gilead, Abbvie, Merck, Janssen
The following authors have nothing to disclose: Benjamin E. Hudson, Alex J.
Walker
1141
Patterns of Care Since the Approval of New Therapies
for Hepatitis C Virus (HCV) Infection: A 2013-2014 Real-
World Analysis of US Community Specialty Practices
Paul J. Gaglio 2 , Tamar Sapir 1 , Jeffrey D. Carter 1 , Laurence
Greene 1 , Erica Rusie 1 , Kathleen Moreo 1 ; 1 PRIME Education, Inc.,
Tamarac, FL; 2 Hepatology, Montefiore Medical Center, Bronx, NY
Background: From 2013 to 2014, approval of all-oral therapies
was associated with dramatic changes in managing HCV.
To assess “real-world” use of HCV therapy and management
trends, we conducted a retrospective study of 50 US community
practices. Methods: The cohort comprised 17 hepatologists,
17 gastroenterologists, and 16 infectious disease specialists
across the US. Charts of adult HCV patients were reviewed for
2013 (n = 300) and 2014 (n = 500). Charts were abstracted
for patient and disease characteristics, care processes, adherence
to HCV quality measures, and prescribing patterns. T-tests
or chi-square tests were used to analyze differences in means
for 2013 and 2014. Results: From 2013 to 2014, patient
demographics, risk factors, disease characteristics, and comorbidities
were as follows: average age (51 vs 54 yrs p=.07),
time since diagnosis (8 vs 5 yrs, p=.04), GT1 (75% vs 76%,
p=.75), GT2 (9% vs 10%, p=.77), GT3 (13% vs 10%, p=.15),
substance abuse (41% vs 33%, p