The critical need for pharmacist involvement in the management of patients with hepatitis C.

Hepatitis C virus (HCV) infection is a global and national health issue, affecting an estimated 170 million people worldwide and 4 million people in the United States.1,2 Approximately 80% of infected individuals will develop chronic HCV infection, which may result in substantial morbidity and mortality due to the development of hepatic fibrosis, liver cirrhosis, and hepatocellular carcinoma.1 Annually, between 8,00010,000 deaths result from HCV infection in the United States.2 It has been estimated that direct medical costs secondary to HCV infection will reach $10.7 billion in the United States by the year 2019.2 The high cost of HCV drug therapy, close patient followup, and laboratory monitoring for virologic response and adverse effects contribute to this staggering figure. In this issue of JMCP, Mariño et al. present the results of their study assessing the impact of pharmacists in management of patients with chronic HCV infection, specifically genotype 1 infection, in a secondary-care hospital in Catalonia, Spain.3 A convenience sample of 50 treatment-naïve patients initiating therapy with once-weekly subcutaneous peginterferon alfa-2b and twice-daily oral ribavirin received consultation from pharmacists throughout the entire course of therapy. Pharmacists provided oral and written disease and drug information, including education about treatment of adverse drug reactions, proper storage of medications, methods of drug administration, and management of missed doses. These visits were provided in tandem with the attending hepatologists at the study site. The authors described an overall sustained virologic response (SVR) of 48%, which is comparable to that observed in other trials of patients with genotype 1 HCV.4 They noted that this SVR may have been increased by the low rate of early treatment discontinuation in the study. Additionally, the overall mean adherence rate was 85.7%; the adherence rate in the patients achieving SVR was an impressive 95.5%.3 The authors are commended for focusing their study on the benefits of pharmacist involvement in management of chronic HCV infection. They intervened on patients with genotype 1 virus, a type that is challenging to eradicate due to the lengthy treatment duration required. The study was strengthened by the visual assessment of adherence at each visit using inspection of patients’ pill boxes, providing a more accurate assessment of adherence than does patient self-report. The role of the pharmacist is clearly delineated in this study, from the pharmacist’s role as an educator to motivator for those patients experiencing an early virologic response at 12 weeks. Along with their face-toThe Critical Need for Pharmacist Involvement in the Management of Patients With Hepatitis C