Epidemiologic Characteristics Determining the Choice of Direct-Acting Antiviral Therapy in HCV Patients: An Italian Real-World Evidence Study.

Pangenotypic direct-acting antivirals (pDAAs) have transformed hepatitis C virus (HCV) treatment. In Italy, sofosbuvir/velpatasvir (SOF/VEL) and glecaprevir/pibrentasvir (GLE/PIB) are available. While both show similar efficacy, differences in patient profiles and potential drug-drug interactions (DDIs) may influence treatment choice. This study examined factors affecting pDAA selection and potential prescribing gaps. Using administrative databases (2018-2023) covering 3.7 million citizens, HCV patients were divided into SOF/VEL and GLE/PIB cohorts and compared by demographic, clinical, and therapeutic data. Among 5565 patients, 2837 (51%) received SOF/VEL and 2728 (49%) received GLE/PIB. SOF/VEL patients were older (60.8 vs. 57.6 years, p < 0.001) and had more comorbidities: diabetes (24% vs. 17%), mental disorders (22% vs. 14%), cancer (14% vs. 9%), and cardiovascular disease (31% vs. 22%). Hospitalization rates were higher (19% vs. 13%), as were exemption codes for chronic hepatitis (58% vs. 50%) and hypertension (32% vs. 23%). Polypharmacy was more common with SOF/VEL; 25% used ≥10 non-pDAA drugs (vs. 17%), and mean medications per patient were higher (6.3 ± 5.6 vs. 4.9 ± 5.2). SOF/VEL was often used for older, frailer patients, likely due to a more favourable DDI profile. These prescribing trends highlight the importance of tailoring pDAA choice to patient comorbidity profiles, ensuring appropriate and individualized HCV treatment.