(SLA-001) Predictors of Adherence to Second Generation Direct Acting Anti-viral Agents among Hepatitis C Virus Infected Patients without Cirrhosis

Background: The advent of direct-acting antivirals (DAAs) in 2011 revolutionized Hepatitis C Virus (HCV) treatment. In addition, the 2nd generation DAAs have better effectiveness in terms of stained virological response and adverse effects profiles than previous regimens. However, adherence to DAA remains to be a challenge, particularly among HCV patients without cirrhosis.

Objectives: To determine the factors associated with adherence to 2nd generation DAA in HCV patients without cirrhosis.

Methods: This retrospective cohort study utilized the Merative MarketScan database (2017–2019) to evaluate 2nd generation DAAs adherence patterns among adult HCV patients without cirrhosis. Patients initiating DAAs were selected with a 12-month baseline washout and a 3-month follow-up period. Medication adherence was measured using the Proportion of Days Covered (PDC), with a PDC of ≥80% considered adherent. Predictors of DAA adherence were evaluated using multivariable logistic regression based on the Andersen Behavioral Model. Sensitivity analysis was conducted at a stringent PDC threshold of ≥90% to assess the robustness of the findings.

Results: Among 3,393 with incident 2nd generation DAA users, 2,577 (75.95%) were non-cirrhotic. Among these HCV patients, 67.52% were adherent (PDC ≥80%). Older age (55–65 years, adjusted odds ratio [aOR]: 1.42; 95%CI:1.06–1.89) was significantly associated with higher odds of adherence compared to younger adults (18–34 years). Patients with comorbid conditions, including hypertension (2.67; 95%CI: 2.17–3.29), hypothyroidism (aOR:1.87; 95%CI: 1.33–2.62), rheumatoid arthritis (aOR: 2.07; 95%CI: 1.22–3.49), and depression/anxiety (aOR: 1.72; 95% CI: 1.28–2.31), found to have a higher likelihood of adherence. However, patients having emergency department visits during the baseline period (aOR: 0.75; 95%CI: 0.60–0.93) were less likely to be adherent. Sensitivity analysis resulted in similar findings with PDC ≥90%.

Conclusions: Over two-thirds of HCV patients without cirrhosis were adherent to 2nd generation DAA. Several clinical and non-clinical factors were associated with DAA adherence. Concerted efforts are needed to understand and address the barriers to DAA adherence to maintaining stained virological response and effectively manage HCV patients without cirrhosis.