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A Survey of Hepatitis C Treatment Clinical Practice Patterns Using the Newly Approved Protease Inhibitors

Chen, Emerson Y. BA*; Lee, William M. MD*; Hynan, Linda S. PhD†,‡; Singal, Amit G. MD, MS*,†

Journal of Clinical Gastroenterology: October 2013 - Volume 47 - Issue 9 - p 800–806
doi: 10.1097/MCG.0b013e31828a37c0

Goals: To describe current hepatitis C virus (HCV) treatment practices in the United States and identify physician characteristics associated with the use of first generation direct-acting antivirals (DAAs).

Background: HCV treatment practice patterns have not been assessed after the introduction of DAA, which are now considered standard of care for most HCV genotype 1 patients.

Study: We sampled nationally representative physicians treating HCV patients with DAAs through a web-based survey. Stepwise multivariate logistic regression was performed to identify physician characteristics associated with the use of DAAs in 4 clinical vignettes (early stage fibrosis, prior null response, human immunodeficiency virus (HIV) co-infection, and post-liver transplantation).

Results: Of 1658 deliverable emails, 337 (20.3%) clinicians responded. Fifty percent of providers recommended DAA therapy for treatment-naive patients with early stage fibrosis, whereas 49% of providers would await new therapies. For prior null responders with significant fibrosis, 74% would attempt retreatment using DAAs and 26% would await new therapies. Off-label use of DAAs was recommended by 69% of providers for patients with HIV infection and 48% of providers for post-liver transplant patients. Academic affiliation was significantly associated with higher rates of off-label use in both HIV and post-liver transplant patients.

Conclusions: Despite more potent and less toxic therapies on the horizon, many physicians recommended DAAs in treatment-naive patients with early stage fibrosis. Providers also frequently recommended DAAs for off-label uses, such as treating post-liver transplant patients and those coinfected with HIV.

*Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center and Parkland Health and Hospital System

Departments of Clinical Sciences

Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX

This work was conducted with support from UT-STAR, NIH/NCATS Grant Number KL2 RR024983-05, CTSA NIH Grant UL1-RR024982, and the ACG Junior Faculty Development Award awarded to A.G.S. The content is solely the responsibility of the authors and does not necessarily represent the official views of UT-STAR, the University of Texas Southwestern Medical Center at Dallas and its affiliated academic and health care centers, the National Center for Advancing Translational Sciences, or the National Institutes of Health. This work was also supported by a grant from the Doris Duke Charitable Foundation to UT Southwestern Medical Center to fund clinical research fellow E.Y.C. Additional funding was supplied by the Rollin and Mary Ella King Fund in the Southwestern Medical Foundation.

The authors declare that they have nothing to disclose.

Reprints: Amit G. Singal, MD, MS, Dedman Scholar of Clinical Care, Division of Gastroenterology, University of Texas Southwestern, 5959 Harry Hines Blvd., P.O.Box 1, Suite 420, Dallas TX 75390-8887 (e-mail:

Received October 3, 2012

Accepted January 28, 2013

© 2013 by Lippincott Williams & Wilkins