Infectious Disease

90-day fills for chronic hepatitis B treatments increased patient adherence

March 16, 2023

2 min read

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Disclosures:
The authors report no relevant financial disclosures.

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Key takeaways:

  • Overall, rates of adherence to entecavir and tenofovir disoproxil fumarate were high among commercially insured adults in the US (83% and 81%, respectively).
  • A 90-day supply or mixed supply was associated with adherence to either antiviral treatment.

Being prescribed a 90-day or a “mixed duration” supply of entecavir or tenofovir disoproxil fumarate was associated with higher fill rates among likely insured patients with chronic hepatitis B, researchers found.

“There has been a lot of important research on barriers that prevent patients with chronic hepatitis B (CHB) from receiving the care they need,” Jonathan D Alpern, MD, assistant professor of medicine at the University of Minnesota, told Healio. “However, less is known about barriers to medication adherence in this population.”

IDN0323Alpern_Graphic_01_WEB

Alpern JD, et al. Open Forum InfectDis. 2023;doi:10.1093/ofid/ofad118.

Alpern added that this is a “really important issue” because “nonadherence in this population can have severe clinical consequences.”

Jonathan D Alpern

“We know that both entecavir and tenofovir can be cost-prohibitive for some patients. Studies in other populations have found that supply duration can also influence adherence,” he said. “We wanted to understand whether these factors (ie, cost, supply duration, etc.) are associated with nonadherence in patients with CHB so that we can better target interventions to improve adherence in this population.”

Alpern and colleagues collected data on commercially insured adult patients with CHB who were prescribed entecavir or tenofovir disoproxil fumarate (TDF) in 2019 to evaluate risk factors for nonadherence to antiviral therapy. The primary outcome was adherence to either entecavir or TDF.

In total, 770 patients were prescribed entecavir and 852 were prescribed TDF, with approximately 53% of patients taking entecavir and 51% of patients taking TDF receiving 30-day supplies (53% and 51%), 36% and 34% receiving 90- day supplies and 11% and 15% receiving a mixed number of days of supply per fill. Overall, 83% of patients who took entecavir and 81% of patients who took TDF were adherent.

Among those treated with entecavir, 90-day supply (adjusted OR = 2.21; P < .01) or mixed supply (aOR = 2.19; P = .04) compared with a 30-day supply, and using a mail-order pharmacy ( aOR = 1.92, P = .03) were associated with adherence to entecavir, whereas 90-day supply (aOR = 2.51; P < .01), mixed supply (aOR = 1.82; P = .04) and use of a high- deductible health plan vs. no high-deductible health plan (aOR = 2.29; P = .01) were associated with adherence to TDF, whereas out-of-pocket spending of more than $25 per 30-day supply was associated with reduced odds of Adherence to TDF vs. less than $5 per 30-day supply (AOR = 0.34; P < .01).

“Clinicians should consider prescribing 90-day fills for their patients with CHB who are taking TDF or entecavir,” Alpern concluded.

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