Adherence to ribavirin in chronic hepatitis C patients on antiviral treatment: Results from a randomized controlled trial using real-time medication monitoring

Summary Background and objective Adherence is essential in antiviral therapy for chronic hepatitis C. We investigated the effect of real-time medication monitoring on adherence to ribavirin. Methods In this randomized controlled trial, patients in the intervention group received a medication dispens...

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Published in:Clinics and research in hepatology and gastroenterology 2016-11, Vol.40 (5), p.622-630
Main Authors: van Vlerken, Lotte G, Lieveld, Faydra I, van Meer, Suzanne, Koek, Ger H, van Nieuwkerk, Karin M.J, Friederich, Pieter, Arends, Joop E, Siersema, Peter D, Burger, David M, van Erpecum, Karel J
Format: Article
Language:English
Subjects:
Antiviral Agents - blood
Antiviral Agents - therapeutic use
Drug Monitoring - instrumentation
Female
Gastroenterology and Hepatology
Hepatitis C, Chronic - drug therapy
Humans
Interferon-alpha - therapeutic use
Internal Medicine
Male
Medication Adherence
Middle Aged
Oligopeptides - therapeutic use
Proline - analogs & derivatives
Proline - therapeutic use
Ribavirin - blood
Ribavirin - therapeutic use
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Summary:Summary Background and objective Adherence is essential in antiviral therapy for chronic hepatitis C. We investigated the effect of real-time medication monitoring on adherence to ribavirin. Methods In this randomized controlled trial, patients in the intervention group received a medication dispenser that monitored ribavirin intake real-time during 24 weeks PEG-interferon/ribavirin ± boceprevir or telaprevir. Patients in the control group received standard-of-care. Adherence was also measured by pill count. Results Seventy-two patients were assigned to either intervention ( n = 35) or control groups ( n = 37). Median adherence by pill count was 96% (range: 43%–100%) with 30 (94%) of patients exhibiting ≥ 80% adherence. Perfect adherence (i.e. 100%) was similar in intervention and control groups: 22 (85%) vs. 15 (75%) ( P = 0.47). Adherences by real-time medication monitoring and by pill count did not correlate ( R = 0.19, P = 0.36). No predictors of poor adherence could be identified. Ribavirin trough levels after 8 weeks (median: 2.4 vs. 2.7 mg/L, P = 0.30) and 24 weeks (median: 3.0 vs. 3.0 mg/L, P = 0.69), and virological responses did not differ between intervention and control groups. Conclusions Adherence to ribavirin during PEG-interferon containing therapy in chronic hepatitis C is high. Real-time medication monitoring did not influence adherence to ribavirin, plasma ribavirin levels or virological responses.
ISSN:2210-7401
2210-741X
DOI:10.1016/j.clinre.2015.12.014