Title: Lack of patient compliance in real-world practice negatively affects sustained viral response rates to direct-acting agent therapy for hepatitis C –M. C. Marshall, et. al.
Source: Dig Dis Sci. 2018 Aug 20. doi: 10.1007/s10620-018-5247-5. [Epub ahead of print]
Study Aims and Results: To assess patient compliance in taking hepatitis C (HCV) medications, completing therapy and with follow-up visits.
The authors retrospectively analyzed data of 261 genotype 1 treatment-naïve (never been treated) and treatment-experienced patients treated with Harvoni (ledipasvir plus sofosbuvir). Before beginning treatment, the patients were counseled on the importance of taking all of their medications, attending their laboratory appointments and returning for their post-treatment follow-up.
The cure rates of those who adhered to treatment vs. those who did not were 95% vs. 74% respectively. The cure rates in the treatment-naïve vs. treatment-experienced group were 68% vs. 86% respectively. In the entire study, 7% discontinued treatment early and 15% didn’t return for post-treatment follow-up. The treatment-naïve patients were less likely to return for post-treatment assessment compared to the treatment-experienced patients (28% vs. 11%).
Conclusion: In this retrospective analysis a significant number of people treated were noncompliant to DAA therapy despite being counseled on the importance of adherence. Treatment-naïve patients were less adherent than treatment-experienced patients.
Editorial Comments: At first, I was surprised by the study results, but after thinking it through I remembered that compliance with treatment is one of the most difficult issues of drug treatment. I think the bright spot in the study is in two areas:
- The people who were compliant achieved a 95% cure rate in real-world settings.
- The treatment-experienced group had a high rate of compliance suggesting that higher adherence may be due to prior treatment experience.
Perhaps other tools like electronic reminders and further outreach to patients would have helped. Since this was an abstract, I don’t know all of the outreach efforts the investigators used.
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