Impact of Sofosbuvir-Based Therapy on Liver Transplant Candidates with Hepatitis C Virus Infection.

Abstract

BACKGROUND:

Sofosbuvir use in patients with decompensated cirrhosis may be associated with reduced liver transplant waitlist mortality and reduced need for transplant.

METHODS:

Data from the Scientific Registry of Transplant Recipients were linked with a national database of pharmacy claims. All adult patients on the liver transplant waitlist on January 1, 2014, or added to the list during 2014, with hepatitis C virus as reason for listing were identified (2009 patients). A subgroup of 1093 unique patients had consistent pharmacy claim capture and observations. We compared patients who were and were not treated with all sofosbuvir-based regimens.

RESULTS:

During the study period, 154 patients received sofosbuvir-based regimens. These patients had lower model for end-stage liver disease scores and significantly longer waiting times. We found a trend toward significance for more sofosbuvir-treated than untreated patients being removed from the waitlist due to improved condition (4.54% vs 3.19%, p=0.03). In a propensity score-adjusted analysis, sofosbuvir-treated patients were less likely to undergo transplant (hazard ratio 0.57, 95% confidence interval 0.37-0.89, p=0.01).

CONCLUSION:

During the study period reflecting early sofosbuvir use, few liver transplant candidates received sofosbuvir. Use was associated with lower incidence of transplant and a trend toward more waitlist removals due to improved condition.

• Authors: Bethany Dellay, Anne Sexter, Jeffrey H Wang, Gregory P Hess, W Ray Kim, Ajay K Israni
• Journal: Pharmacotherapy (Pharmacotherapy) Vol. 39 Issue 4 Pg. 424-432 (04 2019) ISSN: 1875-9114 [Electronic] United States
• PMID: 30779203 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2019 Pharmacotherapy Publications, Inc.

Chemical References

• Antiviral Agents
• Sofosbuvir

Topics

• Adolescent
• Adult
• Aged
• Antiviral Agents (administration & dosage, therapeutic use)
• Female
• Hepatitis C (drug therapy, virology)
• Humans
• Liver Cirrhosis (prevention & control, virology)
• Liver Function Tests
• Liver Transplantation (statistics & numerical data, trends)
• Male
• Middle Aged
• Proportional Hazards Models
• Sofosbuvir (administration & dosage, therapeutic use)
• Transplant Recipients (statistics & numerical data)
• Waiting Lists
• Young Adult