Treatment of hepatitis C virus infection in people with opioid use disorder: a real-world study of elbasvir/grazoprevir in a US Department of Veterans Affairs population

ABSTRACT

Background: Hepatitis C virus (HCV) infections in the United States have increased in recent years, with the most rapid rise among people who inject drugs (PWIDs). Historically, there have been concerns regarding treatment adherence among PWIDs with HCV infection, leading to undertreatment of this population and increased HCV transmission. Elbasvir (EBR)/grazoprevir (GZR) has demonstrated high rates of virologic cure (sustained virologic response [SVR]) in clinical trials enrolling PWIDs with HCV infection.

Objective: To evaluate the real-world effectiveness of EBR/GZR in HCV genotype (GT) 1–infected patients with a diagnosis of opioid use disorder.

Methods: A retrospective analysis of electronic medical records from the US Department of Veterans Affairs Corporate Data Warehouse. Adults with chronic HCV GT1 infection, ≥1 prescription for EBR/GZR, and ≥1 clinic visit were included. All patients had ≥1 ICD-9/10 code of opioid use disorder. SVR was the primary outcome.

Results: 419 patients were included; 97.1% had a history of any illicit drug use and 40.8% were receiving medication for opioid use disorder (MOUD). SVR was achieved by 96.9% (406/419) of all patients, 97.0% (350/361) of those receiving EBR/GZR for 12 weeks, and 95.3% (163/171) of those receiving MOUD. SVR in patients receiving psychiatric medications ranged from 96.1% (221/230) in those taking antidepressant medications to 98.5% (128/130) in those taking mood stabilizers.

Conclusion: In this real-world setting, high rates of virologic cure were achieved in patients with HCV GT1 infection on MOUD receiving EBR/GZR for 12 weeks, including patients with multiple comorbidities and high rate of psychiatric medication use.

KEYWORDS:

• Retrospective
• hepatitis C virus
• Veterans Affairs
• opioid use

Acknowledgments

Medical writing assistance was provided by Tim Ibbotson, PhD, of ApotheCom (Yardley, PA, USA) and funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Disclosure statement

JRK, FK, and HE-S have received grant support from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. AP is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, and shareholder of Merck & Co., Inc., Kenilworth, NJ, USA. YC and XY report no relevant disclosures. FK has received grant support from Gilead and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Data availability statement

All aggregated analyses tables generated during this study are included in this published article. De-identified patient-level datasets generated and/or analyzed in the study are not available due to the restrictions from the VA to not release patient-level data.

Additional information

Funding

Funding for this study was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. This material is also the result of work supported by resources at the VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety [#CIN 13-413] at the Michael E. DeBakey VA Medical Center, Houston, TX, USA, where Jennifer R. Kramer, Xian Yu, Yumei Cao, and Fasiha Kanwal are employees.