Paving Pathways For Hepatitis C Treatment
Pharmacists’ Strategies For Removing Obstacles In Pursuit of
Achieving Sustained Virological Response
Michelle T. Martin, PharmD, BCPS, BCACP
Rebekah L. Hanson, PharmD, BCPS, BCACP
University of Illinois Hospital and Health Sciences System | Chicago College of Pharmacy
The authors report no financial conflicts with any products discussed in this paper.
Introduction
The field of hepatitis C virus (HCV) treatment has had
groundbreaking changes in the last 3 years with the
introduction of several novel direct acting antiviral
(DAA) agents with increased sustained virologic
response (SVR) rates and reduced treatment duration
compared to previous treatment with pegylated
interferon (PegIFN) and ribavirin (RBV). Individuals
who previously failed therapy, or were ineligible
for standard treatment with PegIFN and RBV, now
have an improved chance to achieve SVR. New
obstacles accompany these new agents. Providers
must consider drug interactions, side effect profiles,
concomitant diagnoses, and the patient’s ability
to adhere to treatment regimens, necessary lab
monitoring, and lifestyle changes, before initiating
HCV treatment. Medication adherence is paramount
for successful response to HCV treatment.
Medication access is vital, yet the high cost of the
new DAAs is a burden to many patients and the
health care system. This article will describe how
clinical pharmacists can contribute to overcoming
HCV treatment obstacles in order to increase the
likelihood of achieving SVR.
Education
Our hepatology service is a multidisciplinary
team consisting of pharmacists, nurses, mid-level
practitioners, and physicians. The pivotal role of
the clinical pharmacist starts at the time a patient
is evaluated for HCV treatment initiation. The
clinical pharmacist provides new referral evaluation
for appropriateness of therapy, group education
classes, extensive one-on-one patient education
at the initiation of HCV treatment, ongoing followup assessments, treatment response monitoring,
and other clinical services needed by the team. The
pharmacist’s expertise and provision of education
to providers and patients increases the likelihood of
appropriate treatment candidate selection and patient
adherence with the HCV regimen.
The pharmacist is the key player in the provision of
HCV education in our clinic. The initial discussion
about HCV treatment with the patient includes a
conversation about the risks and benefits of HCV
treatment. Patients are informed that early, successful
HCV treatment can halt the progression of their
liver disease, prevent associated complications,
and reduce the risk of HCV-related death. It is
important that patients understand the mode of
HCV transmission, and are counseled on avoiding
behavior that can lead to spread of the infection.
Patients are informed of what HCV genotype they
have, and what treatment options they have based
on their genotype.
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