Theme: Epidemiology & Public Health Research Year: 2025
| Background: People who use drugs (PWUD) are at a high risk of HCV infection and often have psychiatric disorders requiring antipsychotic drugs, which, can produce drug-drug interactions (DDIs) with direct-acting antivirals (DAAs). This study evaluated potential DDIs between DAAs and concomitant medications used in PWUD/antipsychotics-treated HCV patients; specially in the co-use of quetiapine and methadone, both with known risk in QTc prolongation.
Methods: This retrospective cohort study examined patients treated with SOF/VEL or GLE/PIB using IQVIA PharMetrics Plus claims data from 07/2015 to 06/2023. The use of antipsychotic drugs during DAA was analyzed. The PWUD population and the use of opioid substitution therapy (OST) for each DAA was subsequently identified, evaluating the risk of DDIs using the Liverpool DDI tracker. Results: Patients on antipsychotics represented 3.7% (420/11,324) of the total cohort, 3.9% (267/6,784) treated with SOF/VEL and 3.4% (153/4,540) with GLE/PIB. Out of 178 PWUD patients on antipsychotics (42.4%), 106 (60%) were treated with SOF/VEL and 72 (40%) with GLE/PIB. There were no demographic differences among DAA groups. Among the 106 patients on SOF/VEL, DDI risk was present in 14 patients (13.2%; 2 for clinically significant DDIs -CSDDI- and 12 for weak DDIs -WDDI). For the 72 GLE/PIB treated patients, 100% were on DDI risk (57 for CSDDI and 15 for WDDI). Quetiapine was the most common antipsychotic involved in the DDI risk with SOF/VEL (63) and GLE/PIB (42), followed by aripiprazole and Lurasidone. Interestingly, 8 patients receiving quetiapine were also on methadone as OST, with 4 on SOF/VEL and 4 on GLE/PIB. Conclusion: Antipsychotic use in US PWUD population represents a similar proportion compared to previous non-US studies. Despite HCV treatment guidelines recommendations, the use of Protease Inhibitors-based DAA shows an increased risk of DDIs, specially with the use of QTc prolongation based medications like quetiapine and methadone. |