A survey of hepatitis C treatment clinical practice patterns using the newly approved protease inhibitors

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Abstract

GOALS:: To describe current hepatitis C virus (HCV) treatment practices in the United States and identify physician characteristics associated with the use of first generation direct-acting antivirals (DAAs). BACKGROUND:: HCV treatment practice patterns have not been assessed after the introduction of 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 4 clinical vignettes (early stage fibrosis, prior null response, human immunodeficiency virus (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-naive patients with early stage fibrosis, whereas 49% of providers would await new therapies. For prior null responders with significant fibrosis, 74% would attempt retreatment 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-naive patients with early stage fibrosis. Providers also frequently recommended DAAs for off-label uses, such as treating post-liver transplant patients and those coinfected with HIV.

Original languageEnglish (US)
Pages (from-to)800-806
Number of pages7
JournalJournal of Clinical Gastroenterology
Volume47
Issue number9
DOIs
Publication statusPublished - Oct 2013

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Keywords

  • Direct-acting antiviral
  • HCV
  • Protease inhibitors
  • Survey
  • Therapy

ASJC Scopus subject areas

  • Gastroenterology

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