A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD

Balk, Ethan M; Adam, Gaelen P; Jadoul, Michel; Martin, Paul; Gordon, Craig E.

doi:10.1016/j.ekir.2022.11.008

Cited by 8 publications

(5 citation statements)

References 129 publications

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“…Sofosbuvir, which is still the backbone of many DAA regimens in developing countries, was also found to be safe. KTRs with eGFR > 30 mL/min/1.73 m 2 , similar to our study cohort, experienced both high efficacy and safety with the evaluated regimens, including daclatasvir/sofosbuvir [56]. The DAA regimen we employed is particularly advantageous in KTRs due to minimal drug interactions, as evidenced by studies showing that daclatasvir, despite being a CYP3A4 substrate, and sofosbuvir do not impact the pharmacokinetic parameters of critical immunosuppressive medications such as tacrolimus, everolimus, or cyclosporine [57,58].…”

Section: Discussionsupporting

confidence: 78%

Shear Wave Elastography for Assessing Liver Stiffness in HCV-Infected Kidney Transplant Recipients after Direct-Acting Antiviral Treatment: A Comparative Study with Magnetic Resonance Elastography

Almutawakel,

Halleck,

Dürr

et al. 2023

JCM

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Hepatitis C virus (HCV) infection can lead to hepatic fibrosis. The advent of direct-acting antivirals (DAAs) has substantially improved sustained virological response (SVR) rates. In this context, kidney transplant recipients (KTRs) are of particular interest due to their higher HCV infection rates and uncertain renal excretion and bioavailability of DAAs. We investigated liver stiffness after DAA treatment in 15 HCV-infected KTRs using ultrasound shear wave elastography (SWE) in comparison with magnetic resonance elastography (MRE). KTRs were treated with DAAs (daclatasvir and sofosbuvir) for three months and underwent SWE at baseline, end of therapy (EOT), and 3 (EOT+3) and 12 months (EOT+12) after EOT. Fourteen patients achieved SVR12. Shear wave speed (SWS)—as a surrogate parameter for tissue stiffness—was substantially lower at all three post-therapeutic timepoints compared with baseline (EOT: −0.42 m/s, p < 0.01; CI = −0.75–−0.09, EOT+3: −0.43 m/s, p < 0.01; CI = −0.75–−0.11, and EOT+12: −0.52 m/s, p < 0.001; CI = −0.84–−0.19), suggesting liver regeneration after viral eradication and end of inflammation. Baseline SWS correlated positively with histopathological fibrosis scores (r = 0.48; CI = −0.11–0.85). Longitudinal results correlated moderately with APRI (r = 0.41; CI = 0.12–0.64) but not with FIB-4 scores (r = 0.12; CI = −0.19–0.41). Although higher on average, SWE-derived measurements correlated strongly with MRE (r = 0.64). In conclusion, SWE is suitable for non-invasive therapy monitoring in KTRs with HCV infection.

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Section: Discussionsupporting

confidence: 78%

Shear Wave Elastography for Assessing Liver Stiffness in HCV-Infected Kidney Transplant Recipients after Direct-Acting Antiviral Treatment: A Comparative Study with Magnetic Resonance Elastography

Almutawakel,

Halleck,

Dürr

et al. 2023

JCM

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“…This study found that more than half of all CKD cases were caused by hypertension or diabetes, which is associated with a high risk of CKD developing ESRD that requires hemodialysis, as suggested by Balk EM, et al [ 18 ] and Ekpanyapong and Reddy [ 19 ]. Another disease affecting a younger age group is BSSKD, which is also prevalent.…”

Section: Discussionmentioning

confidence: 75%

Sofosbuvir and Velpatasvir Regimen Outcome for Chronic Hepatitis C Patients With End-Stage Renal Disease Undergoing Hemodialysis

Shahid,

Asghar,

Mahmood

et al. 2023

Cureus

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BackgroundPatients on hemodialysis (HD) are most likely to contract hepatitis C (HCV) infection, which is associated with significant morbidity and disease progression. Direct-acting antivirals (DAAs) are safe and tolerable in chronic kidney disease (CKD) with a 90-100% cure rate, and limited data exist regarding their efficacy in end-stage renal disease (ESRD), particularly for HD patients in South Asia.The study aimed to assess the outcome of a 12-week sofosbuvir (SOF) and velpatasvir (VEL) treatment regimen on ESRD patients with chronic HCV infection undergoing HD in the Pakistani Asian population. Methodology

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“…It is worth noting that although the current analysis showed no overall differences in SVR rates in patients treated with these options compared to genotype-specific regimens, we documented their significantly lower effectiveness in men and patients with cirrhosis. It is difficult to clearly comment on these findings and refer to other studies due to the different effectiveness reported for individual DAA regimens, both in clinical trials and real-world studies, depending on the baseline characteristics of the analyzed populations [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Real-world effectiveness of genotype-specific and pangenotypic direct-acting antivirals in HCV-infected patients with renal failure

Tronina,

Brzdęk,

Zarębska-Michaluk

et al. 2023

ceh

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Aim of the study The aim is to summarize the effectiveness and safety of genotype-specific and pangenotypic hepatitis C virus (HCV) treatments in patients with renal failure. Material and methods In the EpiTer-2 database, which includes data from 22 hepatology centers in Poland, 593 patients with HCV infection and kidney failure were identified. According to KDIGO 2022, they fulfilled the criteria of chronic kidney disease. Patients were divided into two groups: treated with genotype-specific regimens ( n = 428) and pangenotypic options ( n = 165), in relation to the stage of kidney disease determined using the glomerular filtration rate (GFR) (Cockcroft and Gault equation). Two separate groups were created for hemodialyzed patients ( n = 134) and patients after kidney transplantation ( n = 89). Results In a total of 593 patients, 78.7% were treatment-naïve and 23.9% had liver cirrhosis, in 27.5% of cases decompensated. In both groups, the dominant genotype was GT1b. Among patients treated with genotype-specific regimens, LDV/SOF ± RBV, OBV/PTV/r + DSV ± RBV, and GZR/EBR ± RBV treatments were given to 31.5%, 31.5%, and 34.8% of patients respectively. In pangenotypic regimens, GLE/PIB was chosen in 50.3%. Ninety-six percent and 98.8% of patients in the genotype-specific regimen and 88.5% and 94.8% in the pangenotypic regimen achieved a sustained virologic response at 12 weeks (SVR12) in the intention-to-treat and per protocol population respectively. Liver cirrhosis was identified as a risk factor for virological failure. During the study, 14 patients died, 7 in each of the two groups, none related to the antiviral treatment. Conclusions Both types of treatment regimens are equally effective and safe in patients with renal failure. The stage of renal failure or transplant does not influence the antiviral response.

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A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD

Cited by 8 publications

References 129 publications

Shear Wave Elastography for Assessing Liver Stiffness in HCV-Infected Kidney Transplant Recipients after Direct-Acting Antiviral Treatment: A Comparative Study with Magnetic Resonance Elastography

Shear Wave Elastography for Assessing Liver Stiffness in HCV-Infected Kidney Transplant Recipients after Direct-Acting Antiviral Treatment: A Comparative Study with Magnetic Resonance Elastography

Sofosbuvir and Velpatasvir Regimen Outcome for Chronic Hepatitis C Patients With End-Stage Renal Disease Undergoing Hemodialysis

Real-world effectiveness of genotype-specific and pangenotypic direct-acting antivirals in HCV-infected patients with renal failure

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