title: A survey of hepatitis C treatment clinical practice patterns using the newly approved protease inhibitors.
abstract: OBJECTIVE
  To describe current hepatitis C virus (HCV) treatment practices in the United States and identify physician characteristics associated with the use of first generation direct-acting antivirals (DAAs).
  
  
  BACKGROUND
  HCV treatment practice patterns have not been assessed after the introduction of DAA, which are now considered standard of care for most HCV genotype 1 patients.
  
  
  METHODS
  We sampled nationally representative physicians treating HCV patients with DAAs through a web-based survey. Stepwise multivariate logistic regression was performed to identify physician characteristics associated with the use of DAAs in 4 clinical vignettes (early stage fibrosis, prior null response, human immunodeficiency virus (HIV) co-infection, and post-liver transplantation).
  
  
  RESULTS
  Of 1658 deliverable emails, 337 (20.3%) clinicians responded. Fifty percent of providers recommended DAA therapy for treatment-naive patients with early stage fibrosis, whereas 49% of providers would await new therapies. For prior null responders with significant fibrosis, 74% would attempt retreatment using DAAs and 26% would await new therapies. Off-label use of DAAs was recommended by 69% of providers for patients with HIV infection and 48% of providers for post-liver transplant patients. Academic affiliation was significantly associated with higher rates of off-label use in both HIV and post-liver transplant patients.
  
  
  CONCLUSIONS
  Despite more potent and less toxic therapies on the horizon, many physicians recommended DAAs in treatment-naive patients with early stage fibrosis. Providers also frequently recommended DAAs for off-label uses, such as treating post-liver transplant patients and those coinfected with HIV.
authors.affiliation: *Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center and Parkland Health and Hospital System Departments of †Clinical Sciences ‡Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Emerson Y
authors.initials: EY
authors.lastname: Chen
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
authors.forename: Linda S
authors.initials: LS
authors.lastname: Hynan
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005838:Genotype; D019538:Health Care Surveys; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056687:Off-Label Use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D014481:United States
chemical_list: D000998:Antiviral Agents; D011480:Protease Inhibitors