High Rates of Comorbidities and Polypharmacy in Patients with Chronic Hepatitis C in Germany: Results of a large cross-sectional study

Background: The potential future healthcare burden of hepatitis C is now generally accepted. More patients will be able to benefit from cure with newly approved direct-acting antiviral agents (DAA); however, there is evidence of potential for drug-drug interactions (DDI). We investigated the demographics, prevalence of co-morbidities and co-medications with DDI potential among chronic hepatitis C (CHC) patients in Germany.

Methods: This large cross-sectional study analysed electronic patient records from 737 general practitioners (GP) and 36 gastroenterologists in Germany (IMS® Disease Analyzer) during the study period (01/2011 – 12/2014). Inclusion criteria consisted of ICD-10 diagnosis of CHC and follow up in the same practice during at least one year prior to the last consultation date. Diagnoses and prescriptions 12 months prior to the last physician consultation were analyzed. Co-morbidities were analyzed using ICD-10 codes. Co-medications with DDI or DDI potential for new HCV DAAs were obtained from an established hepatitis DDI database www.hep-druginteractions.org/.

Results: Of the 5,205 patients (pts) with CHC identified for the study period, 3,083 met the inclusion criteria and were included in the analysis. 41% were female. Mean age was 51 years old, 52% were above 50, and 25% above 60. Results are summarised in the table. Most frequent co-morbidities (% pts): chronic pain (22%), hypertension (22%), and depression (15%). Prevalence of co-morbidities generally increased with age however polytoxicomania was highest in those 18 – 49 years old (17%). On average, each CHC patient received 2.4 co-medications. Most common medication groups (% pts): cardiovascular (38%), pain (37%), respiratory (32%), and antidepressants (18%). 62% of all patients received at least one, and 37% received ≥2 medications with DDI potential with at least one of the new DAAs.

Conclusion: Our results suggest significant levels of comorbidities and co-medications with DDI potential among real world CHC patients. Prevalence of comorbidities and co-medication increases with age. Treating physicians need to be aware of the DDI potential when considering appropriate treatment regimens, in particular for those with multiple co-medications.

	All patients	< 18 years	18 – 29 years	30 – 39 years	40 – 49 years	50 – 59 years	60 – 69 years	≥70 years
Number of patients	3,083	2	133	574	763	853	344	414
Co-morbidities
Chronic pain syndromes	21.8%	0.0%	16.5%	19.0%	19.9%	22.5%	24.7%	27.3%
Hypertension	21.2%	0.0%	3.0%	4.2%	10.9%	22.4%	38.4%	53.1%
Depression	15.1%	0.0%	15.8%	12.9%	16.3%	15.8%	11.9%	16.7%
Chronic Gastritis	10.8%	0.0%	4.5%	9.1%	10.0%	11.0%	13.4%	14.3%
Gastro Esophagel Reflux Disease	9.7%	0.0%	3.8%	6.3%	7.7%	10.9%	11.6%	16.2%
Polytoxicomania	9.1%	0.0%	19.5%	17.2%	12.,5%	6.6%	1.5%	0.0%
Diabetes Type 2	7.9%	0.0%	0.0%	1.4%	3.1%	8.6%	14.5%	21.7%
Dyslipidemia	6.3%	0.0%	2.3%	1.7%	2.6%	6.3%	11.6%	16.2%
Chronic obstructive pulmonary disease	6.0%	0.0%	0.8%	3.1%	5.0%	7.7%	7.6%	8.9%
Alcohol abuse	5.4%	0.0%	4.5%	5.9%	8.9%	6.0%	2.,3%	0.0%
Coronary heart diseases	4.8%	0.0%	0.0%	0.7%	1.2%	4.3%	6.1%	18.8%
Arrhythmias	4.8%	0.0%	0.0%	0.7%	1.6%	3.2%	7.8%	19.1%
Asthma	4.5%	0.0%	2.3%	2.4%	5.0%	5.3%	4.7%	5.8%
Congestive heart failure	3.5%	0.0%	0.8%	0.0%	0.7%	2.2%	2.3%	18.1%
Chronic Kidney Disease	2.7%	0.0%	0.8%	0.2%	0.7%	2.2%	3.8%	10.9%
Number of contraindicated or not recommended co-medication
1 substance	25.9%	0.0%	25.6%	27.5%	29.8%	26.0%	23.0%	18.8%
2 substances	16.0%	0.0%	11.3%	14.3%	14.4%	17.7%	16.6%	18.8%
3 substances	8.6%	0.0%	6.0%	3.7%	8.5%	10.0%	10.2%	12.1%
4 substances	5.7%	0.0%	0.8%	2.8%	3.7%	6.0%	7.8%	13.0%
>= 5 substances	6.6%	0.0%	2.3%	0.7%	4.1%	5.3%	11.6%	19.1%