Author(s)
Curry M1, Bae H2, Dieterich D3, Ankoma-Sey V4, Reddy R5, Pan C6, Hann HW7, Tong M8, Kim WR9, Kwo P9, Frazier L10, Cox K11, Milligan S11, Afdhal N1
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2St. Vincent Medical Center, Asian Pacific Liver Center, Los Angeles, CA, USA, 3Mount Sinai School of Medicine, New York, NY, USA, 4Liver Associates of Texas, P.A., Houston, TX, USA, 5University of Pennsylvania, Philadelphia, PA, USA, 6NYU Langone Health, NYU School of Medicine, New York, NY, USA, 7Thomas Jefferson University Hospital, Philadephia, PA, USA, 8Huntington Medical Research Institute Liver Center, Pasadena, CA, USA, 9Stanford University School of Medicine, Stanford, CA, USA, 10Liver Wellness Center, Little Rock, AR, USA, 11Trio Health Analytics, La Jolla, CA, USA
OBJECTIVES Here, we describe changes in HBV treatment in the 24 months after TAF approval as observed in a US network of 10 HBV-care centers. METHODS Data were retrospectively obtained from patient records through an electronic registry at enrollment (Nov 2016) with further collection at each patient visit. Of 1037 enrolled patients, 725 patients with 24-month follow up were included in this study. RESULTS 7% (50/725) patients were untreated at enrollment and throughout the observation period (Nov 2016 to Dec 2018). Reasons for non-treatment: 82% (41/50) low HBV DNA, 54% (27/50) normal liver function, 8% (4/50) patient decision, 6% (3/50) HBeAg negative, 2% (1/50) does not meet guidelines, and 2% (1/50) unspecified. In Jan 2017 (end of enrollment), 58% (418/725) patients received tenofovir disoproxil fumarate (TDF), 23% (168/725) entecavir (ETV), and 2% (14/725) TAF. In Dec 2018 (end of the observation period), 30% (218/725) received TDF, 21% (152/725) ETV, and 35% (254/725) TAF. 37% (271/725) patients switched therapies for reasons of safety/side effects (58%, 156/271), physician preference (25%, 69/271), efficacy (8%, 23/271), or insurance/cost (6%, 17/271). Most switches were to TAF (91%, 246/271) from TDF (88%, 217/246). Rate of switching differed by site of care; compared to community practices, academic sites had a lower switch rate (26% [114/441] vs 55% [157/284]). Treatment switches in both academic (81%, 92/114) and community (98%, 154/157) sites were mainly to TAF, but the therapies prior to TAF were more varied in the academic sites. CONCLUSIONS In this study, 7% of patients were untreated while 37% received >1 regimen during the observation window. Reasons for non-treatment were mainly low HBV DNA and normal liver function. For the population receiving treatment, initial regimens were mostly TDF and ETV. Switches away from initial therapy was mainly due to safety/side effects concerns and were predominately to TAF.
Conference/Value in Health Info
2020-05, ISPOR 2020, Orlando, FL, USA
Value in Health, Volume 23, Issue 5, S1 (May 2020)
Code
PIN8
Topic
Clinical Outcomes, Health Service Delivery & Process of Care
Topic Subcategory
Clinical Outcomes Assessment, Disease Management, Prescribing Behavior, Treatment Patterns and Guidelines
Disease
Infectious Disease (non-vaccine)