Utilizing Clinical Pharmacist Specialist to Manage Hepatitis C Virus Patients on Direct-Acting Antiviral Therapy
Utilizing Clinical Pharmacist Specialist to Manage Hepatitis C Virus Patients on Direct-Acting Antiviral Therapy
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DOI：
10.1177/0897190018777345
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发表时间：
2019-12-01
影响因子：
1.3
通讯作者：
Mambourg, Scott E.
中科院分区：
文献类型：
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作者：
Mikolas, Lena A.;Jacques, Kimberly;Mambourg, Scott E.
目的：评价临床药师（CPS）管理的丙型肝炎病毒（HCV）治疗诊所（HCVTC）使用直接作用抗病毒药物（DAAs）治疗丙型肝炎感染退伍军人的效果。方法：我们与传染病医生（IDP）建立了一个由cps管理的HCVTC。2014年11月1日至2015年11月30日期间，共有132名退伍军人接受了治疗。CPS参与了预处理筛选、药物选择、患者教育、药物咨询、药物治疗监测、药物使用审查、解决药物依从性问题以及患者常规和治疗后随访，以评估12周治疗后的持续病毒学反应（SVR）。结果：在CPS管理的132例患者中，87例（66%）患者采用ledipasvir/sofosbuvir (LDV/SOF)， 29例（22%）患者采用paritaprevir/ritonavir/ombitasvir + dasabuvir (PrOD)， 16例（12%）患者采用sofosbuvir （SOF）为基础的方案。相应方案的SVR率分别为92% （n = 80）、100% （n = 29）和93.8% （n = 15）。我们对HCV基因型1 （GT-1）的SVR率为94%，对GT-2至GT-4的SVR率为100%。不同治疗方案的总SVR率为94%，未接受治疗的患者为93%，有治疗经验的患者为96%，非肝硬化患者为93%，代偿性肝硬化患者为94%。结果与DAAs关键试验中报告的SVR数据相当。结论：CPS可有效应用于经DAAs治疗的hcv感染患者的药物治疗管理。
Objectives: To evaluate outcomes of a clinical pharmacist specialist (CPS)-managed hepatitis C virus (HCV) treatment clinic (HCVTC) in treating HCV-infected veterans with direct-acting antivirals (DAAs). Methods: We established a CPS-managed HCVTC under a collaborative practice agreement with our infectious disease physician (IDP). A total of 132 veterans were treated between November 1, 2014, and November 30, 2015. The CPS engaged in pretreatment screening, drug selection, patient education, medication counseling, drug therapy monitoring, drug utilization review, addressing issues on drug adherence, and routine and posttreatment follow-up of patients to assess sustained virologic response (SVR) after 12 weeks of treatment. Results: Of 132 patients managed by the CPS, 87 (66%) were treated with ledipasvir/sofosbuvir (LDV/SOF), 29 (22%) with paritaprevir/ritonavir/ombitasvir + dasabuvir (PrOD), and 16 (12%) with sofosbuvir (SOF)-based regimen. The corresponding regimens demonstrated a SVR rate of 92% (n = 80), 100% (n = 29), and 93.8% (n = 15), respectively. We achieved an SVR rate of 94% against HCV genotype 1 (GT-1) and 100% against GT-2 to GT-4. The overall SVR rate was 94% across regimens, showing 93% in treatment-naive patients and 96% in treatment-experienced patients, and 93% in noncirrhotic and 94% in compensated cirrhotic patients. The results were comparable to SVR data reported in pivotal trials for DAAs. Conclusion: The results suggest that CPS could be effectively utilized in drug therapy management of HCV-infected patients treated with DAAs.