Letter: telaprevir triple therapy in chronic hepatitis C genotype 1 patients receiving haemodialysis

Maasoumy, Benjamin; Buggisch, Peter; Buslau, A.; Schiefke, Ingolf; Berg, Thomas; Wedemeyer, Heiner; Sarrazin, Christoph; Hinrichsen, Holger

doi:10.1111/apt.12748

Cited by 16 publications

(11 citation statements)

References 10 publications

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“…Data of small HCV cohorts on maintenance haemodialysis treated with PegIFN/ribavirin plus a NS3 protease inhibitor (telaprevir or boceprevir) showed an interesting virological efficacy but was associated with high rate of side effects. [53][54][55].…”

Section: Treatment Of Hcv Infection In Patients With Renal Diseasementioning

confidence: 99%

Hepatitis C virus infection and chronic kidney disease: Time for reappraisal

Cacoub

Desbois

Isnard-Bagnis

et al. 2016

Journal of Hepatology

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Hepatitis C virus (HCV) infection is associated with tremendous morbidity and mortality due to liver complications. HCV infection is also associated with many extrahepatic manifestations including cardiovascular diseases, glucose metabolism impairment, cryoglobulinemia vasculitis, B cell non-Hodgkin lymphoma and chronic kidney disease (CKD). Many studies have shown a strong association between HCV and CKD, by reporting (i) an increased prevalence of HCV infection in patients on haemodialysis, (ii) an increased incidence of CKD and proteinuria in HCV-infected patients, and (iii) the development of membranoproliferative glomerulonephritis secondary to HCV-induced cryoglobulinemia vasculitis. HCV seropositivity is found to be associated with an increased relative risk for all-cause and cardiovascular mortality in the dialysis population. HCV seropositivity is linked to lower patient and graft survival after kidney transplantation. Such poor HCV-associated prognosis should have encouraged clinicians to treat HCV in CKD patients. However, due to frequent side effects and the poor efficacy of interferon-based treatments, very few HCV dialysis patients have received HCV medications until now. The emergence of new direct acting, interferon-free antiviral treatment, leading to HCV cure in most cases with a satisfactory safety profile, will shortly modify the management of HCV infection in CKD patients. In patients with a glomerular filtration rate (GFR) >30ml/min, the choice of DAA is not restricted. In those with a GFR <30 and >15ml/min, only paritaprevir/ritonavir/ombitasvir/dasabuvir or a grazoprevir plus elbasvir regimen are approved. In patients with end stage renal disease (GFR <15ml/min or dialysis), current data only allows for the use of a grazoprevir plus elbasvir combination. No doubt these data will be modified in the future with the advent of new studies including larger cohorts of HCV patients with renal impairment.

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Section: Treatment Of Hcv Infection In Patients With Renal Diseasementioning

confidence: 99%

Hepatitis C virus infection and chronic kidney disease: Time for reappraisal

Cacoub

Desbois

Isnard-Bagnis

et al. 2016

Journal of Hepatology

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“…First-generation protease inhibitors in combination with pegylated interferon and ribavirin gave potentially interesting results[110-113], but the observed high antiviral efﬁcacy was accompanied by numerous serious adverse effects[112]. …”

Section: Experiences On Anti-hcv Therapies In Populations At Renal Riskmentioning

confidence: 99%

Anti-hepatitis C virus drugs and kidney

Carrier

Essig

Debette-Gratien

et al. 2016

WJH

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Hepatitis C virus (HCV) mainly targets the liver but can also induce extrahepatic manifestations. The kidney may be impacted via an immune mediated mechanism or a cytopathic effect. HCV patients are clearly at a greater risk of chronic kidney disease (CKD) than uninfected patients are, and the presence of CKD increases mortality. Interferon-based therapies and ribavirin are difficult to manage and are poorly effective in end-stage renal disease and hemodialysis. These patients should be given priority treatment with new direct anti-viral agents (DAAs) while avoiding peginterferon and ribavirin. The first results were convincing. To aid in the correct use of these drugs in patients with renal insufficiency, their pharmacokinetic properties and potential renal toxicity must be known. The renal toxicity of these new drugs was not a safety signal in clinical trials, and the drugs are generally efficient in these frail populations. These drugs are usually well tolerated, but recent cohort studies have demonstrated that these new regimens may be associated with renal side effects, especially when using sofosbuvir combinations. HCV, renal diseases and comorbidities are intimately linked. The close monitoring of renal function is required, particularly for at-risk patients (transplanted, HIV-coinfected, CKD, hypertensive or diabetic patients). New DAA regimens, which will soon be approved, will probably change the landscape.

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“…Three of their four patients achieved viral clearance at week 12; however, no further outcomes were reported, and the number of SVRs is unknown. Wiegand et al treated seven hemodialysis patients with Peg-IFN- α , ribavirin, and telaprevir [ 9 ]: the duration of treatment ranged from 24 to 47 weeks. A SVR was observed in six of their seven patients [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Boceprevir-Based Triple Antiviral Therapy for Chronic Hepatitis C Virus Infection in Kidney-Transplant Candidates

Mehawej

Rostaing

Alric

et al. 2015

Journal of Transplantation

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Background. There are few data on the combination of (pegylated-) interferon- (Peg-IFN-) α, ribavirin, and first-generation direct-acting antiviral agents (DAAs). Our aim was to describe the efficacy and safety of Peg-IFN-α, ribavirin, and boceprevir in hemodialysis patients. Patients. Six hemodialysis patients, chronically infected by genotype-1 HCV, were given Peg-IFN-α (135 µg/week), ribavirin (200 mg/d), and boceprevir (2400 mg/d) for 48 weeks. Results. At initiation of antiviral therapy, median viral concentration was 5.68 (3.78–6.55) log IU/mL. HCV RNA was undetectable in four of the six patients at week 4 and in all patients at week 24. A breakthrough was observed in two patients between weeks 24 and 48, and a third patient stopped antiviral therapy between weeks 24 and 48 because of severe peripheral neuropathy. At week 48, HCV RNA was undetectable in three patients. Of these, two patients relapsed within a month after antiviral therapy was stopped. Hence, only one patient had a sustained virological response; he was a previous partial responder. Overall, anemia was the main side effect. Conclusion. A triple antiviral therapy based on Peg-IFN-α, ribavirin, and boceprevir is not optimal at treating hemodialysis patients with chronic HCV infection. Studies using new-generation drugs are required in this setting.

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Letter: telaprevir triple therapy in chronic hepatitis C genotype 1 patients receiving haemodialysis

Cited by 16 publications

References 10 publications

Hepatitis C virus infection and chronic kidney disease: Time for reappraisal

Hepatitis C virus infection and chronic kidney disease: Time for reappraisal

Anti-hepatitis C virus drugs and kidney

Boceprevir-Based Triple Antiviral Therapy for Chronic Hepatitis C Virus Infection in Kidney-Transplant Candidates

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