High Virologic Cure Rates for Hepatitis C Virus among Veterans with Opioid Use Disorder Treated with Elbasvir/Grazoprevir
BACKGROUND:
Between 2004 and 2014, new hepatitis C virus (HCV) infections increased by 400%, and admissions for opioid injection increased by 622% among people aged 18 to 29 years. Elbasvir (EBR)/grazoprevir (GZR) is a fixed-dose combination treatment for HCV; however, information on its efficacy in real-world populations of people who inject drugs, who frequently have comorbidities or are receiving concomitant medications, is lacking. This retrospective study sought to evaluate the real-world effectiveness of EBR/GZR among Veterans with HCV genotype (GT) 1 who also had a diagnosis of opioid use disorder (OUD). Using VA data, investigators identified 419 VA patients who had been diagnosed with OUD and with chronic HCV (GT1) infection, who also had initiated ≥1 prescription for EBR/GZR between January 28, 2016, and August 31, 2017 (treatment initiation period). Patient demographics and comorbidities (i.e., cirrhosis, diabetes, depression) also were assessed, in addition to medications for OUD. The primary outcome was sustained virologic response (SVR) at 12 weeks after completion of therapy.
FINDINGS:
- High rates of virologic cure were achieved among VA patients with HCV, OUD, and multiple comorbidities, including very high rates of psychiatric medication use, after receiving EBR/GZR for 12 weeks. Overall, 97% of Veterans achieved sustained virologic response.
- SVR rates were high regardless of baseline characteristics, comorbidities, or concomitant medications. SVR was achieved by 95% of Veterans receiving medication for OUD (MOUD) – and by 98% of Veterans who were not receiving MOUD.
- A total of 128 Veterans were reported as homeless during the year prior to initiating treatment; 98% of those Veterans achieved SVR.
IMPLICATIONS:
- This first real-world evaluation of EBR/GZR in a population of patients with OUD suggests that treatment for 12 weeks represents an effective option for patients with HCV GT1 infection receiving MOUD, including people who inject drugs.
LIMITATIONS:
- Overall, 95% of patients enrolled in this study were male; however, important gender differences between male and female individuals with substance use disorder suggest that caution may be required in extrapolating data from the present study to females.
- The use of ICD-9/10-CM codes to identify diagnoses and comorbidities may have led to misclassification bias.
AUTHOR/FUNDING INFORMATION:
This study was partly supported by HSR&D. Drs. Kramer, Cao, El-Serag, and Kanwal are part of HSR&D’s Center for Innovations in Quality, Effectiveness and Safety (IQuESt) in Houston, TX.
Kramer J, Puenpatom A, Cao Y, Yu X, El-Serag H, and Kanwal F. 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. The American Journal of Drug and Alcohol Abuse. January 25, 2022; online ahead of print.
