Let’s Do This

Guest Blog: Kimberly M. Hicks, Pharm.D., M.H.A.

It’s a tough road from diagnosis to treatment, but many hepatitis C patients – in spite of this path of uncertainty – step up to the challenge and say with unrelenting courage: “Let’s Do This.”

As a clinical pharmacist providing drug therapy management and counseling to hepatitis C patients, I am often astonished at my patients’ courage during the treatment process. To be blunt, the side effect profile of hepatitis C treatment is generally grueling. Yet time and again I see patients committed to doing whatever it takes to combat this virus.

Suffering Side Effects for the Chance of a Cure
Hepatitis C patients can suffer for weeks from flu-like symptoms which sometimes make it extremely difficult to even get out of bed. Additionally, some patients experience numerous sleepless nights due to insomnia caused by the treatment. Then, when you add on long days of fatigue, shortness of breath, and weakness caused by anemia, you can see what a challenge treatment can be for patients. Emotionally, many patients endure days of anxiety, depression, and frustration. Despite all of this, I am amazed by how many patients stick with their treatment regimen and remain steadfastly committed to their journey to better health.

Most of the hepatitis C patients who I counsel have already been through at least one round of treatment in the past. Yet they did not clear the virus because they were “poor responders.” Last year a new treatment medication was approved by the FDA and many patients have decided with “tippy-toe” excitement to give the new treatment a try.

This new treatment is based on protease inhibitors combined with two additional medications (ribavirin and pegylated interferon). Patients who were considered poor responders to past treatment now seem encouraged and very optimistic by this new opportunity to fight the virus and to achieve a sustained virological response.

A sustained virological response, in regards to hepatitis C, means that the hepatitis C virus is undetectable in a patient’s blood. According to the April 2010 issue of the journal Hepatology, the latest data supports sustained virological response being measured and considered definitive at 12 weeks after completion of therapy. Previously, patients were directed to wait until 24 weeks after therapy completion to determine their sustained virological response.

The hepatitis C virus has at least six different genotypes. The majority of cases in the United States are genotype 1. Genotype 1 patients who have been identified as poor responders to treatment are therefore perfect candidates for the new triple therapy treatment regimen. In fact, this medication combination provides a meaningful cure for up to 70 percent of patients with genotype 1 virus.

I can recall many conversations with patients who felt hesitant to consider treatment because of the daunting side effects. But when these patients understood the outcome data with the triple combination therapy and what it means to obtain a sustained virological response, it wasn’t long until I heard the reluctance in their voices change to courage and conviction as they saw a path open before them that could lead to clearing this virus.

Offering Patient Support
Hepatitis C is too complicated for patients to handle the management of triple drug therapy alone. Management of the hepatitis C virus is best done with the supervision and care from an integrative health care team. The patient, however, has a very important role in this team: as the historian. The historian must inform and communicate effectively regarding the signs, symptoms, and past medical history in order for the physician, nurse, pharmacist, psychologist, and other team members to understand how to best treat and provide clinical support to the patient.

At BioPlus Specialty Pharmacy, our clinical pharmacists offer counseling to each newly admitted patient who is starting the triple therapy of protease inhibitors, pegylated interferon, and ribavirin. We understand that if a patient is willing to tackle the challenge of treating this complex virus then the least we can do is throw them the ball of support so they can make a touchdown.

Dr. Stephen Vogt, President and CEO of BioPlus, challenged our clinical team to a commitment goal for our patients. He based this challenge on many hours of counseling patients, reviewing compliance data, and identifying the clinical, emotional, and physical challenges that each patient may encounter. His challenge to each clinical team member at BioPlus is to make sure that each patient who begins therapy with BioPlus will be:

• Offered drug therapy management counseling
• Provided patient education about adverse reactions
• Given overall clinical monitoring
• Educated about ways to increase adherence
• Provided a drug utilization review

At BioPlus we believe that combining a courageous patient with a competent clinical team can achieve excellent adherence to therapy and overall positive outcomes when treating the hepatitis C virus.