LAUSR

Our recent exploratory study indicated several direct-acting antivirals (DAAs), highly effective medications for hepatitis C virus (HCV) infection, were also associated with improvement in posttraumatic stress disorder (PTSD) among a national cohort of United States Department of Veterans Affairs (VA) patients treated between 10/1/99 and 9/30/19. Limiting the same cohort to patients with PTSD and HCV, we compared the associations of individual DAAs with PTSD symptom improvement using propensity score weighting. After identifying patients who had available baseline and endpoint PTSD symptom data as measured with the PTSD Checklist (PCL), we compared changes over the 8-12 weeks of DAA treatment. The DAAs most prescribed in conjunction with PCL measurement were glecaprevir/pibrentasvir (GLE/PIB; n=54), sofosbuvir/velpatasvir (SOF/VEL; n=54), and ledipasvir/sofosbuvir (LDV/SOF; n=145). GLE/PIB was superior to LDV/SOF, with a mean difference in improvement of 7.3 points on the PCL (95% confidence interval [CI] 1.1, 13.6). The mean differences in improvement on the PCL were smaller between GLE/PIB and SOF/VEL (3.0; 95% CI -6.3, 12.2) and between SOF/VEL and LDV/SOF (4.4; 95% CI -2.4, 11.2). While almost all patients were cured of HCV (92.5%) regardless of the agent received, PTSD outcomes were superior for those receiving GLE/PIB compared to those receiving LDV/SOF, indicating GLE/PIB may merit further investigation as a potential PTSD treatment.