Direct-Acting Antiviral Treatment From Primary Physicians Improves Hepatitis C Treatment: Presented at Liver Meeting

By Matt Silver

SAN FRANCISCO -- November 13, 2018 -- Primary physician-led direct-acting antiviral treatment has the potential to significantly improve access to effective hepatitis C care, according to results of a prospective study presented at The Liver Meeting 2018, the Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

The willingness and enthusiasm of both patients and their primary-care doctors to treat patients with hepatitis outside of the hospital setting has exceeded expectations noted lead author James Thomas, MD, University of Queensland, Queensland, Australia, speaking here on November 13.

The availability of highly effective and well tolerated direct-acting antivirals is increasing as cost decreases, resulting in a capacity issue for current specialist clinic structures. New care models are needed to fully take advantage of the reduced costs, including the expansion of care to “hard-to-treat” patients, such as those who inject drugs, Dr. Thomas explained.

Between March 2016 and August 2017, Dr. Thomas and colleagues asked primary-care doctors in metropolitan practices to fax or e-mail a core dataset for patients with chronic hepatitis C -- including demographics, medical history, abdominal ultrasound and standard laboratory results -- to a study hepatologist. The remote specialist then reviewed the information to assess fibrosis stage, determine the need for further investigation, and plan community direct-acting therapy. These assessments were then returned to the primary-care physician to prescribe direct-acting therapy without requiring routine hospital attendance, doctor-to-doctor teleconference or phone call, or specialist tests.

Of the 230 patients who began direct-acting antiviral therapy via primary care, 9 patients required referral for specialist outpatient assessment.

A total of 226 patients completed therapy. Of the 159 patients who had results available to determine sustained virologic response at 12 weeks, nearly all (99%) showed sustained response.

“Factors such as injecting drug use, opiate use, mental illness, and excess alcohol intake have traditionally been barriers to hepatitis C treatment,” Dr. Thomas said. “This real-world study shows that these [factors] did not appear to affect cure rates or attendance for test of cure in this setting. Treating such ‘at risk’ patients who have been underserved by existing care models is required to eliminate hepatitis C.”

The median age of patients in this study was 42 years; 66% were male. A total of 43% of patients had recently used injection drugs or were currently using them, while 33% were prescribed opiate therapy.

The Liver Meeting 2018 is sponsored and supported by the American Association for the Study of Liver Diseases.

[Presentation title: Direct-Acting Antiviral Therapy in Primary Care Following Non-Real Time, Remote Specialist Review – a Practical Solution to Scaling up HCV Therapy. Abstract 474]

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