Comorbidities and Prescribed Medications in Korean Patients with Chronic Hepatitis C: A Nationwide, Population-Based Study
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: Extrahepatic comorbidities and comedication are important to consider in the treatment of chronic hepatitis C (CHC) patients with direct-acting antivirals (DAAs) due to the risk of drug-drug interaction (DDI) and the effect of comorbidities on clinical outcomes. This study aimed to investigate the detailed profiles of comorbidities and comedication among Korean CHC patients. Methods: All adult patients (≥18 years old) with a primary diagnostic code of CHC in 2013 were selected from the National Health Insurance claims database. For each patient, all ICD-10 codes listed as primary or secondary diagnoses and all prescribed medications were collected. Results: Among 47,104 CHC patients (median age, 57 years; male, 49.3%), 84.8% had at least one comorbidity for a mean number of 2.4, which increased with age. The most prevalent comorbidities were hypertension, esophagitis, dyslipidemia, diabetes mellitus, and peptic ulcer. Overall, 96.8% of the patients took at least one prescribed medication, with a mean of 8.1 medications/ year, and the three most common drug types were analgesics, gastrointestinal agents, and antibacterials. Use of at least one drug with a DDI risk category of “contraindicated medication” or “required dose-reduction/additional monitoring” was observed in 97% of the overall patients. The proportion of prescribed medications that were contraindicated with DAAs varied from 2.0% to 38.9% depending on the hepatitis C virus regimen. Conclusions: The majority of CHC patients had comorbidities; almost all patients took multiple prescribed medications, the number of which increased with age, and significant DDI risk was present in 97% of this Korean patient cohort. Comorbidities and comedication profiles should be considered during DAA therapy.
Abstract
Background/Aims: Extrahepatic comorbidities and comedication are important to consider in the treatment of chronic hepatitis C (CHC) patients with direct-acting antivirals (DAAs) due to the risk of drug-drug interaction (DDI) and the effect of comorbidities on clinical outcomes. This study aimed to investigate the detailed profiles of comorbidities and comedication among Korean CHC patients. Methods: All adult patients (≥18 years old) with a primary diagnostic code of CHC in 2013 were selected from the National Health Insurance claims database. For each patient, all ICD-10 codes listed as primary or secondary diagnoses and all prescribed medications were collected. Results: Among 47,104 CHC patients (median age, 57 years; male, 49.3%), 84.8% had at least one comorbidity for a mean number of 2.4, which increased with age. The most prevalent comorbidities were hypertension, esophagitis, dyslipidemia, diabetes mellitus, and peptic ulcer. Overall, 96.8% of the patients took at least one prescribed medication, with a mean of 8.1 medications/ year, and the three most common drug types were analgesics, gastrointestinal agents, and antibacterials. Use of at least one drug with a DDI risk category of “contraindicated medication” or “required dose-reduction/additional monitoring” was observed in 97% of the overall patients. The proportion of prescribed medications that were contraindicated with DAAs varied from 2.0% to 38.9% depending on the hepatitis C virus regimen. Conclusions: The majority of CHC patients had comorbidities; almost all patients took multiple prescribed medications, the number of which increased with age, and significant DDI risk was present in 97% of this Korean patient cohort. Comorbidities and comedication profiles should be considered during DAA therapy.
참고문헌 (14)
- Smolders EJ, "Cardiovascular risk management and hepatitis C : combining drugs", Clin Pharmacokinet, 58, pp.565~592 (2019)
- Smolders EJ, "The majority of hepatitis C patients treated with direct acting antivirals are at risk for relevant drug-drug interactions", United European Gastroenterol J, 5, pp.648~657 (2017)
- Herold C, "Quantitative testing of liver function in relation to fibrosis in patients with chronic hepatitis B and C", Liver, 21, pp.260~265 (2001)
- Frye RF, "Liver disease selectively modulates cytochrome P450 : mediated metabolism", Clin Pharmacol Ther, 80, pp.235~245 (2006)
- Wyffels K, "Tamoxifen-induced hepatotoxicity caused by drug interaction with direct-acting antiviral agents for hepatitis C", J Oncol Pharm Pract, 25, pp.2038~2040 (2019)
- Bebia Z, "Bioequivalence revisited : influence of age and sex on CYP enzymes", Clin Pharmacol Ther, 76, pp.618~627 (2004)
- Tang L, "Systemic manifestations of hepatitis C infection", Infect Agent Cancer, 11, pp.29~ (2016)
- Zignego AL, "Virus-driven autoimmunity and lymphoproliferation : the example of HCV infection", Expert Rev Clin Immunol, 11, pp.15~31 (2015)
- Pradat P, "Progression to cirrhosis in hepatitis C patients : an agedependent process", Liver Int, 27, pp.335~339 (2007)
- Ruzicka DJ, "Comorbidities and co-medications in populations with and without chronic hepatitis C virus infection in Japan between 2015 and 2016", BMC Infect Dis, 18, pp.237~ (2018)
- Louie KS, "The high comorbidity burden of the hepatitis C virus infected population in the United States", BMC Infect Dis, 12, pp.86~ (2012)
- Hudson B, "Comorbidities and medications of patients with chronic hepatitis C under specialist care in the UK", J Med Virol, 89, pp.2158~2164 (2017)
- Massard J, "Natural history and predictors of disease severity in chronic hepatitis C", J Hepatol, 44, pp.S19~ (2006)
- Joon Yeul Nam, "Epidemiological and Clinical Characteristics of Hepatitis C Virus Infection in South Korea from 2007 to 2017: A Prospective Multicenter Cohort Study", Gut and Liver, 14(2), pp.207~217 (2020), 거트앤리버 소화기연관학회협의회