The above posting is sponsored by Gilead Sciences to support scientific and medical education, and with non-promotional intent.
等线 [Peak Dialogue]Drug-drug interactions of DAA: A very important topic in DAA era
As several phase III studies on treatingchronic hepatitis C with direct-acting antiviral agents have been completed in China, the new era of hepatitis C patients having access to standardized DAA therapies in China is approaching. Meanwhile, Chinese physicians should be well prepared and have a comprehensive understanding of all the related knowledge when using DAAs. Among all these knowledge, drug-drug interactions(DDIs) between DAAs and other concomitant drugs are of great clinical significance. In the following, we will share some suggestions given by Professor Qing Xie from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine and Professor Stefan Zeuzem from J. W. Goethe University Hospital.
Three aspects of managing DDIs of DAAs
Professor Xie told that there will be the launch of DAAs in China this year and Chinese physicians should be prepared. DDIs between DAAs and other concomitant drugs might influence the plasma concentrates of drugs and as a result, reduce the therapeutic effect orincrease the toxicity. Every specialist should pay attention to DDIs. Professor Xie gave Chinese physicians three suggestions on how to manage the DDIs.
First of all, we should thoroughly enquirepatients’ medical history and the medicine they are taking. "Chinese physician are very likely to receive elderly patients with liver cirrhosis and other underlying disease like hypertension and diabetes. Usually, these patients concurrently take drugs to treat these underlying diseases, for example, cardiovascular drug, metabolic disorder drugs and even anti-tuberculoticdrugs. Before prescribing DAAs, we should know all the medications that patients are currently using.”
Secondly, understanding the different DDI profiles of various DAAs regimens. "We need to pay attention to whether the chosen DAA regimen would interact with the concomitant drugs that patientsare taking to treat his/her underlying disease or comorbidities.So, we should review the prescription information carefully, follow the related studies, read the guidelines and utilize our database, then we can learn some of the identified DDIs."
Last but not the least, we should modify the regimens. "When noticing some potential DDIs, in addition to limiting the impact on the basic therapy, we should try our best to choose the drug with lower risk of DDIs or reduce the dosage of relevant drugs, and to avoid or minimize the DDIs between the DAAs and the basic medicine. Additionally, physicians should know that some Chinese herbal medicines can interacted with DAAs."
"Our rule is to avoid using the drugs that are not necessary. If they need to be applied, we should keep our eyes open on preventing and monitoring the potential DDIs as well as the possible consequences related to the DDIs. And when needed, the dosage should be modified." Prof. Xie emphasized.
The management of DDIs is no difficult in nowadays
Prof. Zeuzem shared some insights of managing the DDIs between three major DAAs. "There are very few drug-drug interactions with nucleus acidic NS5B inhibitors. Probably the most worth-noticing drug-drug interaction is amiodarone, which might lead to severe bradycardia and even cardiac mortality. The NS5A inhibitors generally are easy to manage, there are few drug-drug interactions need to be considered and they are reasonably safe drugs. Also, the DDIs of protease inhibitor has been improved a lot. Although several major DDIs are likely to occur to protease inhibitor, with the new drugs are being introduced, these issues have become less prominent. But when physicians including the protease inhibitors into the triple therapy, we must keep in mind that they interact with some statins, such as atorvastatin and some antiretroviral medication, especially efavirenz.” In addition, physicians should search the Liverpool drug-drug interaction database and be aware of the potential DDIs, emphasized by Prof. Zeuzem.
The above posting is sponsored by Gilead Sciences to support scientific and medical education, and with non-promotional intent.