Optimizing hepatitis C virus treatment through pharmacist interventions: Identification and management of drug-drug interactions.
Optimizing hepatitis C virus treatment through pharmacist interventions: Identification and management of drug-drug interactions.
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DOI：
10.3748/wjg.v23.i9.1618
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发表时间：
2017-03-07
影响因子：
4.3
通讯作者：
Kiser JJ
中科院分区：
文献类型：
--
作者：
Langness JA;Nguyen M;Wieland A;Everson GT;Kiser JJ
量化药物-药物相互作用（DDI）的患者处方丙型肝炎病毒（HCV）治疗，所采取的干预措施，并在这一过程中花费的时间。作为标准治疗，临床药剂师在2013年11月至2015年7月期间在科罗拉多大学肝病诊所对处方直接作用抗病毒（DAA）HCV治疗的患者进行DDI筛查。处方的HCV治疗方案包括ledipasvir/sofosbuvir（LDV/SOF）、paritaprevir/ritonavir/ombitasvir/dasabuvir（OBV/PTV/r + DSV）、simeprevir/sofosbuvir（SIM/SOF）和sofosbuvir/ribavirin（SOF/RBV）。这项回顾性分析审查了临床药师完成的工作，以衡量研究确定的目标。使用描述性统计量总结确定的DDI数量和类型。确定了664例患者（83.4%白人，57%男性，平均56.7岁）; LDV/SOF 369例，OBV/PTV/r + DSV 48例，SIM/SOF 114例，SOF/RBV 133例。51.5%的患者患有糖尿病。总体而言，审查了5217种药物（每例患者7.86种药物），并确定了781种相互作用（每例患者1.18种相互作用）。SOF/RBV的相互作用次数最少（每例患者0.17次相互作用），OBV/PTV/r + DSV的相互作用次数最多（每例患者2.48次相互作用）。LDV/SOF和SIM/SOF的相互作用数量相似（每例患者分别为1.28和1.48）。胃酸调节剂和维生素/草药补充剂通常引起与LDV/SOF的相互作用。高血压药物、镇痛药和精神科药物经常与OBV/PTV/r + DSV和SIM/SOF相互作用。为了管理这些相互作用，药剂师最常建议停药（28.9%），增加对毒性的监测（24.1%）或分开给药时间（18.2%）。药剂师对每位患者的病历审查通常需要大约30分钟，对于更复杂的患者需要额外的时间。DDI是常见的HCV药物和管理可能需要药物调整和增加监测。包括临床药剂师在内的跨学科团队可以优化患者护理。
To quantify drug-drug-interactions (DDIs) encountered in patients prescribed hepatitis C virus (HCV) treatment, the interventions made, and the time spent in this process. As standard of care, a clinical pharmacist screened for DDIs in patients prescribed direct acting antiviral (DAA) HCV treatment between November 2013 and July 2015 at the University of Colorado Hepatology Clinic. HCV regimens prescribed included ledipasvir/sofosbuvir (LDV/SOF), paritaprevir/ritonavir/ombitasvir/dasabuvir (OBV/PTV/r + DSV), simeprevir/sofosbuvir (SIM/SOF), and sofosbuvir/ribavirin (SOF/RBV). This retrospective analysis reviewed the work completed by the clinical pharmacist in order to measure the aims identified for the study. The number and type of DDIs identified were summarized with descriptive statistics. Six hundred and sixty four patients (83.4% Caucasian, 57% male, average 56.7 years old) were identified; 369 for LDV/SOF, 48 for OBV/PTV/r + DSV, 114 for SIM/SOF, and 133 for SOF/RBV. Fifty-one point five per cent of patients were cirrhotic. Overall, 5217 medications were reviewed (7.86 medications per patient) and 781 interactions identified (1.18 interactions per patient). The number of interactions were fewest for SOF/RBV (0.17 interactions per patient) and highest for OBV/PTV/r + DSV (2.48 interactions per patient). LDV/SOF and SIM/SOF had similar number of interactions (1.28 and 1.48 interactions per patient, respectively). Gastric acid modifiers and vitamin/herbal supplements commonly caused interactions with LDV/SOF. Hypertensive agents, analgesics, and psychiatric medications frequently caused interactions with OBV/PTV/r + DSV and SIM/SOF. To manage these interactions, the pharmacists most often recommended discontinuing the medication (28.9%), increasing monitoring for toxicities (24.1%), or separating administration times (18.2%). The pharmacist chart review for each patient usually took approximately 30 min, with additional time for more complex patients. DDIs are common with HCV medications and management can require medication adjustments and increased monitoring. An interdisciplinary team including a clinical pharmacist can optimize patient care.