Adherence to once-daily and twice-daily direct acting antiviral therapy for hepatitis C infection among people with recent injection drug use or current opioid agonist therapy

Evan B. Cunningham (Lead / Corresponding author), Behzad Hajarizadeh, Janaki Amin, Alain H Litwin, Edward Gane, Curtis Cooper, Karine Lacombe, Margaret Hellard, Phillip Read, Jeff Powis, Olav Dalgard, Julie Bruneau, Gail V. Matthews, Jordan J. Feld, John F. Dillon, David Shaw, Philip Bruggmann, Brian Conway, Chris Fraser, Philippa MarksGregory J Dore, Jason Grebely

Research output: Contribution to journalArticle

Abstract

Background: This study investigated treatment adherence and associated factors among people with recent injecting drug use or current opioid agonist therapy (OAT) and compared once-daily to twice-daily DAA therapy.

Methods: SIMPLIFY and D3FEAT are international, multicentre studies which recruited participants with recent injecting drug use (previous six months; SIMPLIFY, D3FEAT) or current OAT (D3FEAT) between March 2016 and February 2017 in eight countries. Participants received sofosbuvir/velpatasvir (once-daily; SIMPLIFY) or paritaprevir/ritonavir/ombitasvir, dasabuvir (twice-daily) ±ribavirin (D3FEAT) for 12 weeks administered in electronic blister-packs. We evaluated overall adherence (proportion of prescribed doses taken) and non-adherence (<90% adherent) with comparisons between dosing patterns.

Results: Of 190 participants who commenced treatment, 184 (97%) completed treatment. Median adherence was 92% with higher adherence among those receiving once-daily vs. twice-daily therapy (94% vs. 87%, P=0.005). Overall, 40% of participants (n=76) were considered non-adherent (<90% adherent). Recent stimulant injecting (odds ratio [OR] 2.48, 95% confidence interval [CI] 1.28-4.82), unstable housing (OR 2.18, 95% CI 1.01-4.70), and receiving twice-daily dosing (OR 2.81, 95% CI 1.47-5.36) were associated with non-adherence. Adherence decreased over the course of therapy SVR was high in non-adherent (89%) and adherent populations (95%, P=0.174) with no difference in SVR between those who did and did not miss at least seven consecutive doses (92% vs 93%, P=0.897).

Conclusion: This study demonstrated high adherence to once- and twice-daily HCV DAA therapy among people with recent injecting drug use or were currently receiving OAT. The levels of non-adherence described did not impact treatment outcomes, suggesting forgiveness to non-adherence.

Original languageEnglish
JournalClinical Infectious Diseases
Early online date2 Nov 2019
DOIs
Publication statusE-pub ahead of print - 2 Nov 2019

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Hepatitis C
Opioid Analgesics
Antiviral Agents
Injections
Infection
Pharmaceutical Preparations
Therapeutics
Odds Ratio
Confidence Intervals
Forgiveness
Ritonavir
Ribavirin
Blister
Multicenter Studies

Keywords

  • HCV
  • treatment
  • PWID
  • drug use
  • injecting drug users
  • adherence
  • OAT

Cite this

Cunningham, Evan B. ; Hajarizadeh, Behzad ; Amin, Janaki ; Litwin, Alain H ; Gane, Edward ; Cooper, Curtis ; Lacombe, Karine ; Hellard, Margaret ; Read, Phillip ; Powis, Jeff ; Dalgard, Olav ; Bruneau, Julie ; Matthews, Gail V. ; Feld, Jordan J. ; Dillon, John F. ; Shaw, David ; Bruggmann, Philip ; Conway, Brian ; Fraser, Chris ; Marks, Philippa ; Dore, Gregory J ; Grebely, Jason. / Adherence to once-daily and twice-daily direct acting antiviral therapy for hepatitis C infection among people with recent injection drug use or current opioid agonist therapy. In: Clinical Infectious Diseases. 2019.
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abstract = "Background: This study investigated treatment adherence and associated factors among people with recent injecting drug use or current opioid agonist therapy (OAT) and compared once-daily to twice-daily DAA therapy.Methods: SIMPLIFY and D3FEAT are international, multicentre studies which recruited participants with recent injecting drug use (previous six months; SIMPLIFY, D3FEAT) or current OAT (D3FEAT) between March 2016 and February 2017 in eight countries. Participants received sofosbuvir/velpatasvir (once-daily; SIMPLIFY) or paritaprevir/ritonavir/ombitasvir, dasabuvir (twice-daily) ±ribavirin (D3FEAT) for 12 weeks administered in electronic blister-packs. We evaluated overall adherence (proportion of prescribed doses taken) and non-adherence (<90{\%} adherent) with comparisons between dosing patterns.Results: Of 190 participants who commenced treatment, 184 (97{\%}) completed treatment. Median adherence was 92{\%} with higher adherence among those receiving once-daily vs. twice-daily therapy (94{\%} vs. 87{\%}, P=0.005). Overall, 40{\%} of participants (n=76) were considered non-adherent (<90{\%} adherent). Recent stimulant injecting (odds ratio [OR] 2.48, 95{\%} confidence interval [CI] 1.28-4.82), unstable housing (OR 2.18, 95{\%} CI 1.01-4.70), and receiving twice-daily dosing (OR 2.81, 95{\%} CI 1.47-5.36) were associated with non-adherence. Adherence decreased over the course of therapy SVR was high in non-adherent (89{\%}) and adherent populations (95{\%}, P=0.174) with no difference in SVR between those who did and did not miss at least seven consecutive doses (92{\%} vs 93{\%}, P=0.897).Conclusion: This study demonstrated high adherence to once- and twice-daily HCV DAA therapy among people with recent injecting drug use or were currently receiving OAT. The levels of non-adherence described did not impact treatment outcomes, suggesting forgiveness to non-adherence.",
keywords = "HCV, treatment, PWID, drug use, injecting drug users, adherence, OAT",
author = "Cunningham, {Evan B.} and Behzad Hajarizadeh and Janaki Amin and Litwin, {Alain H} and Edward Gane and Curtis Cooper and Karine Lacombe and Margaret Hellard and Phillip Read and Jeff Powis and Olav Dalgard and Julie Bruneau and Matthews, {Gail V.} and Feld, {Jordan J.} and Dillon, {John F.} and David Shaw and Philip Bruggmann and Brian Conway and Chris Fraser and Philippa Marks and Dore, {Gregory J} and Jason Grebely",
year = "2019",
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Cunningham, EB, Hajarizadeh, B, Amin, J, Litwin, AH, Gane, E, Cooper, C, Lacombe, K, Hellard, M, Read, P, Powis, J, Dalgard, O, Bruneau, J, Matthews, GV, Feld, JJ, Dillon, JF, Shaw, D, Bruggmann, P, Conway, B, Fraser, C, Marks, P, Dore, GJ & Grebely, J 2019, 'Adherence to once-daily and twice-daily direct acting antiviral therapy for hepatitis C infection among people with recent injection drug use or current opioid agonist therapy', Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciz1089

Adherence to once-daily and twice-daily direct acting antiviral therapy for hepatitis C infection among people with recent injection drug use or current opioid agonist therapy. / Cunningham, Evan B. (Lead / Corresponding author); Hajarizadeh, Behzad; Amin, Janaki; Litwin, Alain H; Gane, Edward; Cooper, Curtis; Lacombe, Karine; Hellard, Margaret; Read, Phillip; Powis, Jeff; Dalgard, Olav; Bruneau, Julie; Matthews, Gail V.; Feld, Jordan J.; Dillon, John F.; Shaw, David; Bruggmann, Philip; Conway, Brian; Fraser, Chris; Marks, Philippa; Dore, Gregory J; Grebely, Jason.

In: Clinical Infectious Diseases, 02.11.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adherence to once-daily and twice-daily direct acting antiviral therapy for hepatitis C infection among people with recent injection drug use or current opioid agonist therapy

AU - Cunningham, Evan B.

AU - Hajarizadeh, Behzad

AU - Amin, Janaki

AU - Litwin, Alain H

AU - Gane, Edward

AU - Cooper, Curtis

AU - Lacombe, Karine

AU - Hellard, Margaret

AU - Read, Phillip

AU - Powis, Jeff

AU - Dalgard, Olav

AU - Bruneau, Julie

AU - Matthews, Gail V.

AU - Feld, Jordan J.

AU - Dillon, John F.

AU - Shaw, David

AU - Bruggmann, Philip

AU - Conway, Brian

AU - Fraser, Chris

AU - Marks, Philippa

AU - Dore, Gregory J

AU - Grebely, Jason

PY - 2019/11/2

Y1 - 2019/11/2

N2 - Background: This study investigated treatment adherence and associated factors among people with recent injecting drug use or current opioid agonist therapy (OAT) and compared once-daily to twice-daily DAA therapy.Methods: SIMPLIFY and D3FEAT are international, multicentre studies which recruited participants with recent injecting drug use (previous six months; SIMPLIFY, D3FEAT) or current OAT (D3FEAT) between March 2016 and February 2017 in eight countries. Participants received sofosbuvir/velpatasvir (once-daily; SIMPLIFY) or paritaprevir/ritonavir/ombitasvir, dasabuvir (twice-daily) ±ribavirin (D3FEAT) for 12 weeks administered in electronic blister-packs. We evaluated overall adherence (proportion of prescribed doses taken) and non-adherence (<90% adherent) with comparisons between dosing patterns.Results: Of 190 participants who commenced treatment, 184 (97%) completed treatment. Median adherence was 92% with higher adherence among those receiving once-daily vs. twice-daily therapy (94% vs. 87%, P=0.005). Overall, 40% of participants (n=76) were considered non-adherent (<90% adherent). Recent stimulant injecting (odds ratio [OR] 2.48, 95% confidence interval [CI] 1.28-4.82), unstable housing (OR 2.18, 95% CI 1.01-4.70), and receiving twice-daily dosing (OR 2.81, 95% CI 1.47-5.36) were associated with non-adherence. Adherence decreased over the course of therapy SVR was high in non-adherent (89%) and adherent populations (95%, P=0.174) with no difference in SVR between those who did and did not miss at least seven consecutive doses (92% vs 93%, P=0.897).Conclusion: This study demonstrated high adherence to once- and twice-daily HCV DAA therapy among people with recent injecting drug use or were currently receiving OAT. The levels of non-adherence described did not impact treatment outcomes, suggesting forgiveness to non-adherence.

AB - Background: This study investigated treatment adherence and associated factors among people with recent injecting drug use or current opioid agonist therapy (OAT) and compared once-daily to twice-daily DAA therapy.Methods: SIMPLIFY and D3FEAT are international, multicentre studies which recruited participants with recent injecting drug use (previous six months; SIMPLIFY, D3FEAT) or current OAT (D3FEAT) between March 2016 and February 2017 in eight countries. Participants received sofosbuvir/velpatasvir (once-daily; SIMPLIFY) or paritaprevir/ritonavir/ombitasvir, dasabuvir (twice-daily) ±ribavirin (D3FEAT) for 12 weeks administered in electronic blister-packs. We evaluated overall adherence (proportion of prescribed doses taken) and non-adherence (<90% adherent) with comparisons between dosing patterns.Results: Of 190 participants who commenced treatment, 184 (97%) completed treatment. Median adherence was 92% with higher adherence among those receiving once-daily vs. twice-daily therapy (94% vs. 87%, P=0.005). Overall, 40% of participants (n=76) were considered non-adherent (<90% adherent). Recent stimulant injecting (odds ratio [OR] 2.48, 95% confidence interval [CI] 1.28-4.82), unstable housing (OR 2.18, 95% CI 1.01-4.70), and receiving twice-daily dosing (OR 2.81, 95% CI 1.47-5.36) were associated with non-adherence. Adherence decreased over the course of therapy SVR was high in non-adherent (89%) and adherent populations (95%, P=0.174) with no difference in SVR between those who did and did not miss at least seven consecutive doses (92% vs 93%, P=0.897).Conclusion: This study demonstrated high adherence to once- and twice-daily HCV DAA therapy among people with recent injecting drug use or were currently receiving OAT. The levels of non-adherence described did not impact treatment outcomes, suggesting forgiveness to non-adherence.

KW - HCV

KW - treatment

KW - PWID

KW - drug use

KW - injecting drug users

KW - adherence

KW - OAT

U2 - 10.1093/cid/ciz1089

DO - 10.1093/cid/ciz1089

M3 - Article

C2 - 31677262

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

ER -