Category: Federal Forum Posters
Purpose: Hepatitis C virus (HCV) is the predominant cause of progressive liver disease, and there is a well-known relationship between chronic HCV and diabetes mellitus (DM). Chronic HCV may promote insulin resistance through various proposed mechanisms. Alternatively, insulin resistance and DM may facilitate the progression of liver disease in chronic HCV patients. Insulin resistance has additionally been shown to decrease SVR in chronic HCV patients treated with older HCV regimens. The purpose of this study was to assess whether DM influences SVR in patients treated with direct-acting antiviral agents (DAAs), and to determine whether insulin-sensitizing agents influence SVR in these patients.
Methods: This study was a retrospective chart review of patients at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois. Patients that received a DAA between January 1st, 2012 and August 31st, 2017 were electronically identified, and those patients that completed a full course of HCV treatment during the approved study period were included. The DAAs used in this study included sofosbuvir (Sovaldi™), simeprevir (Olysio®), sofosbuvir/ledipasvir (Harvoni®), paritaprevir/ombitasvir/ritonavir with dasabuvir (Viekira Pak™), daclatasvir (Daklinza®), elbasvir/grazoprevir (Zepatier®), and sofosbuvir/velpatasvir (Epclusa®), either in combination or in addition to ribavirin (and PEG-IFN for sofosbuvir-based regimens only).
Results: A total of 1021 patients were include in this study, 272 in the diabetic cohort and 749 in the non-diabetic cohort. A significant decrease in SVR was noted in the diabetic cohort versus the non-diabetic cohort (93.8% vs. 96.7%, respectively; p=0.0488). There was no difference in RVR between the groups (p=0.255). Non-cirrhotic patients with DM had lower SVR than those without DM (94.5% vs. 98.5%, respectively; p=0.0091). In the diabetic cohort, a significant decrease in post-HCV treatment A1c was seen in patients that achieved SVR (7.54 ± 1.61 vs. 7.11 ± 1.58; p<0.001). There was also a significantly increased number of patients with an A1c <7% after HCV treatment (p=0.0142), and a trend towards significantly fewer patients with an A1c ≥9% (p=0.0513).
Conclusion: Chronic HCV patients treated with a DAA and with comorbid DM achieve significantly lower SVR than those without DM. Treatment of chronic HCV also improves diabetic control, with respect to both a decrease in mean A1c from baseline and an overall increased number of patients with A1c <7%.
Ashley Santore– PGY2 Health-System Administration Pharmacy Resident, Jesse Brown VA Medical Center, Chicago, IL