Theme: Models of Care Year: 2018
The ongoing SuperDOT-C trial shifts assessment for, and monitoring of, Direct Acting Antiviral
(DAA) treatment for HCV to community pharmacists in the intervention arm. This presents new
challenges for these pharmacists, who take responsibility for patient safety, and of concern is
the burden this new treatment approach may place on the specialist liver service. The standard
of care in NHS Tayside is that prescribing and monitoring of DAA treatment is undertaken by
specially-trained, hospital-based pharmacists and clinic/outreach-based hepatology nurses, who
assess drug-drug interactions and drug-disease risk factors.
Enabling HCV testing and treatment using DAAs among community pharmacists with the
support of a community pharmacist Independent Prescriber (IP), who prescribes trial medication
regimes of Sofosbuvir/Ledipasvir and Sofosbuvir/Daclatasvir. The pharmacist’s safety
evaluation includes: history of concomitant medications (con-meds); evaluation of interactions
with pathway treatment; assessment of blood tests and prior diagnosis; contact with specialist
liver service for advice if required.
Pharmacists identified 111 con-meds for 65 participants (nil con-meds=21; 1 con-med=13; >1
con-meds=31). Of 111 medications, pharmacists identified 5 interacting con-meds across 5
participants. Pharmacists contacted specialist liver services 6 times for advice concerning 3
participants. For 1 participant, 2 potential drug-drug interactions were not identified, but were
later identified by the pharmacist IP. The 5 most-reported con-meds were: Mirtazapine (17),
Gabapentin (11), Salbutamol (6), Amitriptyline (5) and Pregabalin (5). These figures exclude
Methadone, as stable OST prescription is a study inclusion criterion.
Only 6.3% of con-meds interacted with the DAAs, and 5.4% of con-meds led to pharmacist
contact with liver specialists. Further, the 5 most commonly reported con-meds prescribed for
this population do not interact with DAAs used on the trial. These data support the use of
community pharmacists to screen and assess patients for DAA treatment and demonstrates the
impact on specialist liver service is minimal.
Disclosure of Interest Statement: Study funded by Scottish Government. Study drug provided
gratis by Gilead Sciences and Bristol Myers-Squibb