Successful Treatment With Direct-Acting Antiviral Agents of Hepatitis C in Patients With End-Stage Renal Disease and Kidney Transplant Recipients

2019 ◽  
Vol 17 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Diğdem Özer Etik ◽  
◽  
Nuretdin Suna ◽  
Serkan Öcal ◽  
Haldun Selçuk ◽  
...  
Keyword(s):  
Hepatitis C ◽  
End Stage Renal Disease ◽  
Antiviral Agents ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Direct Acting Antiviral ◽  
Stage Renal Disease ◽  
Direct Acting ◽  
End Stage ◽  
Direct Acting Antiviral Agents

‘Real-life’ experience with direct-acting antiviral agents for hepatitis C virus in end-stage renal disease

2018 ◽  
Vol 41 (7) ◽  
pp. 363-370 ◽  
Author(s):  
Rebeca García-Agudo ◽  
Sami Aoufi-Rabih ◽  
Mercedes Salgueira-Lazo ◽  
Carmen González-Corvillo ◽  
Fabrizio Fabrizi
Keyword(s):  
Chronic Kidney Disease ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
End Stage Renal Disease ◽  
Antiviral Agents ◽  
Direct Acting Antiviral ◽  
Stage Renal Disease ◽  
Direct Acting ◽  
End Stage ◽  
Direct Acting Antiviral Agents

Background and Aims: The advent of direct-acting antiviral agents promises to change the management of hepatitis C in patients with end-stage renal disease, a patient group where the treatment of hepatitis C was historically challenging. We investigated the safety and efficacy of all-oral, interferon-free direct-acting antiviral agents for the treatment of hepatitis C in a ‘real-world’ group of patients with end-stage renal disease. Methods: We performed a single-arm, multi-centre study in a cohort (n=30) of patients with advanced chronic kidney disease (mostly on dialysis) who underwent antiviral therapy with direct-acting antiviral agents. The primary end-point was sustained virologic response (serum hepatitis C virus RNA < 15 mIU/mL, 12 weeks after treatment ended). We collected data on on-treatment adverse events, serious adverse events and laboratory abnormalities. Results: In total, 23 (77%) and 7 (23%) patients underwent regular dialysis and had chronic kidney disease at pre-dialysis stage, respectively. Six regimens were adopted: elbasvir/grazoprevir ( n = 6), ledipasvir/sofosbuvir ± ribavirin ( n = 4), PrOD regimens ± ribavirin ( n = 10), simeprevir + daclatasvir ( n = 3), sofosbuvir + daclatasvir ± ribavirin ( n = 3), sofosbuvir + ribavirin ( n = 4). The SVR12 rate was 90% (95% confidence interval, 74%; 96%). A total of 27 (90%) patients achieved SVR12; there were three virologic failures – two were non-responders and one had a viral breakthrough while on therapy. Adverse events occurred in 53% (16/30) (95% confidence interval, 0.39; 0.73) of patients and were managed clinically without discontinuation of therapy or hospitalization. The most common adverse event was anaemia ( n = 12) that required blood transfusions in seven individuals; deterioration of kidney function occurred in one (14%). Conclusion: All-oral, interferon-free therapy with direct-acting antiviral agents for chronic hepatitis C virus in advanced chronic kidney disease was effective and well tolerated in a ‘real-life’ clinical setting. Careful monitoring of haemoglobin and serum creatinine during therapy with direct-acting antiviral agents is suggested. Studies are under way to address whether sustained viral response translates into better survival in this population.

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