期刊
JOURNAL OF CLINICAL GASTROENTEROLOGY
卷 47, 期 9, 页码 800-806出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MCG.0b013e31828a37c0
关键词
direct-acting antiviral; protease inhibitors; HCV; survey; therapy
资金
- UT-STAR
- NIH/NCATS [KL2 RR024983-05]
- CTSA NIH [UL1-RR024982]
- ACG
- Doris Duke Charitable Foundation
- Rollin and Mary Ella King Fund in the Southwestern Medical Foundation
Goals:To describe current hepatitis C virus (HCV) treatment practices in the United States and identify physician characteristics associated with the use of first generation direct-acting antivirals (DAAs).Background:HCV treatment practice patterns have not been assessed after the introduction of DAA, which are now considered standard of care for most HCV genotype 1 patients.Study:We sampled nationally representative physicians treating HCV patients with DAAs through a web-based survey. Stepwise multivariate logistic regression was performed to identify physician characteristics associated with the use of DAAs in 4 clinical vignettes (early stage fibrosis, prior null response, human immunodeficiency virus (HIV) co-infection, and post-liver transplantation).Results:Of 1658 deliverable emails, 337 (20.3%) clinicians responded. Fifty percent of providers recommended DAA therapy for treatment-naive patients with early stage fibrosis, whereas 49% of providers would await new therapies. For prior null responders with significant fibrosis, 74% would attempt retreatment using DAAs and 26% would await new therapies. Off-label use of DAAs was recommended by 69% of providers for patients with HIV infection and 48% of providers for post-liver transplant patients. Academic affiliation was significantly associated with higher rates of off-label use in both HIV and post-liver transplant patients.Conclusions:Despite more potent and less toxic therapies on the horizon, many physicians recommended DAAs in treatment-naive patients with early stage fibrosis. Providers also frequently recommended DAAs for off-label uses, such as treating post-liver transplant patients and those coinfected with HIV.
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