The evolving role of pharmacists in treatment of Hepatitis C

Linda SpoonerThe management of hepatitis C virus (HCV) infection has changed dramatically with the recent approvals of simeprevir (Olysio) and sofosbuvir (Sovaldi) in November and December 2013, respectively. As a result, treatment recommendations for HCV have been revised to reflect updated regimens. Widely varying options are now available, including interferon-free regimens for some patients and treatments of shorter duration for others; these new options have improved treatment success rates for many patients.

These changes provide an opportunity for pharmacists to play a larger role in the management of HCV infection, as they now can participate even more in educating providers and patients about appropriate combinations of medications and the crucial importance of adherence in optimizing clinical outcomes.

Assisting providers

HCV infection requires the use of combination treatment with multiple antiviral agents. The selection of the two or three antiviral agents and the duration of treatment will vary, depending upon the patient’s HCV genotype, prior history of treatment, concomitant comorbidities, and concurrent medications.

Because of the confusion new treatment regimens can cause for primary care and specialty providers, pharmacists are in an ideal position to provide clarification and recommendations in selection of appropriate therapy for individual patients.

Pharmacists can also provide guidance in identification and prevention of drug interactions, as a number of clinically significant drug interactions are associated with the use of these new regimens. By sharing their knowledge of HCV treatment options, pharmacists position themselves as an important part of the multidisciplinary team.

Teaching patients

The prospect of initiating treatment for HCV infection is overwhelming to many patients. They are apprehensive about adverse effects, appropriate self-administration, and medication costs, all common concerns.

Through provision of patient counseling, pharmacists have an ideal opportunity to educate patients about HCV infection, its clinical course, characteristics of the medications used in its treatment, and prevention and management of adverse effects.

In addition, pharmacists can dispel patients’ misconceptions about HCV medications, including misinformation about adverse effects, complementary and alternative medicines, and duration of treatment. Since patients frequently discover inaccurate or outdated information regarding HCV online, a pharmacist can serve as an approachable resource, one who provides accurate facts about treatment.

As optimal treatment adherence is critical for achieving a sustained virologic response, pharmacists can provide useful tools for patients to help prevent them from missing doses, including written treatment schedules, pill boxes, alarm reminders, and tips for linking medication administration with routine daily activities.

Pharmacists also may assist in coordinating auxiliary services for patients, such as information on HCV support groups, services provided by specialty pharmacies, and copayment assistance programs.

Most important, pharmacists can serve as “cheerleaders” for their patients, encouraging and educating them every step of the way as they progress through HCV treatment. This nurtures the relationship between the patient and pharmacist.

The bottom line

Management of HCV infection will continue to evolve as additional therapies are approved and new regimens are created.

By maintaining a strong knowledge base about HCV infection and management, pharmacists have an opportunity to be a resource to providers caring for HCV patients.

Pharmacists also can play an increasingly important role in education of patients. By emphasizing the need for medication adherence and avoidance of drug interactions, they can help patients to optimize therapeutic outcomes.

Linda Spooneris associate professor of pharmacy practice, MCPHS University, Worcester, Mass. E-mail her at linda.spooner@mcphs.edu.