Antiviral therapy (pegylated interferon and ribavirin) of hepatitis C in dialysis patients: meta‐analysis of clinical studies

Fabrizi, F.; Dixit, Vivek; Messa, Piergiorgio; Martin, Paul

doi:10.1111/jvh.12276

Cited by 64 publications

(57 citation statements)

References 30 publications

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“…Our study population was a difficult-to-treat group as the majority of patients had HCV genotype 1 which is a predictor of diminished response to interferon in subjects with intact kidney function; also, the limited number of patients we have included hampers definitive conclusions. However, the results of our study are quite different from those found in patients with hepatitis C and intact kidney function where the SVR rate was less than 15% in patients on monotherapy with recombinant IFN, and a dramatic improvement in SVR rates was noted with the addition of ribavirin, and later with the substitution of peg-IFN instead of standard IFN (50-80% according to HCV genotype) [13].…”

Section: Discussioncontrasting

confidence: 53%

Pegylated Interferon (Alone or With Ribavirin) for Chronic Hepatitis C in Haemodialysis Population

Espinosa

Hernández

Arenas

et al. 2015

Kidney Blood Press Res

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Background/Aims: Hepatitis C virus infection remains prevalent among patients undergoing long-term haemodialysis and has a detrimental impact on survival in this population. Antiviral therapy for chronic hepatitis C in haemodialysis patients is still a challenge to clinicians. The aim of the current study is to evaluate the efficacy and safety of therapy with pegylated interferon, alone or combined with ribavirin, for chronic hepatitis C among patients undergoing long-term hemodialysis. Methods: We conducted a retrospective, multicenter cohort trial with monotherapy (pegylated interferon) (n=21) or combined antiviral therapy (pegylated interferon plus ribavirin) (n=5) for chronic hepatitis C in patients undergoing long-term haemodialysis. Results: Sustained virological response was obtained in eleven (42%) patients. Seven (26.9%) patients interrupted prematurely the antiviral treatment due to serious side-effects, the most frequent cause of treatment withdrawal being hematological (n=3). HCV RNA load was lower in responder than non-responder patients, 5.44 (3.45; 6.36) vs. 5.86 (4.61; 6.46) log₁₀ copies/mL, even if the difference was not significant (P=0.099). Blood transfusion requirement was greater in patients on combined antiviral therapy than those on pegylated interferon alone, 100% (5/5) vs. 0% (0/21), P=0.0001. No difference in sustained viral response occurred between patients on combined antiviral therapy and those on pegylated interferon monotherapy [40% (2/5) vs. 42.8% (9/21), P=0.90]. Conclusions: Results from this study showed that pegylated interferon alone or with ribavirin is unsatisfactory in terms of efficacy and safety. Prospective trials based on interferon-free regimens (i.e., sofosbuvir plus ribavirin or sofosbuvir plus daclatasvir) are under way in patients with hepatitis C receiving long-term hemodialysis.

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Section: Discussioncontrasting

confidence: 53%

Pegylated Interferon (Alone or With Ribavirin) for Chronic Hepatitis C in Haemodialysis Population

Espinosa

Hernández

Arenas

et al. 2015

Kidney Blood Press Res

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“…Among all, 24% dropout were due to anemia and 13% due to infections. 35 Another study on monotherapy of interferon by Esforzado et al showed acure rate of 30-45% in ESRD patients. 36 As therapy of Peg IFN and RBV may cause post transplanted graft rejection, the safety of conventional BEMS Reports, Vol 2, Issue 1, Jan-Jun, 2016 treatment remains an issue to address 37,38 The rapid evolution of interferon-free regimen DAAs changed the perception about the treatment of chronic HCV in difficult to treat group.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Sofosbuvir with Simeprevir in Hepatitis C Infected Patients with Severe Chronic Kidney Disease: A Systematic Review and Meta-Analysis

et al. 2016

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Background & Aims:Conventional treatment (interferon or ribavirin) for Hepatitis C viral (HCV) infection in patients with severe chronic kidney disease (CKD) has limitations of high dropout and less response rate. Directly acting antivirals raise hopes for HCV treatment in these patients. This meta-analysis was performed to evaluate the evidence for efficacy and safety of sofosbuvir and simeprevir, with or without ribavirin, in HCV-infected patients with severe CKD. Methods: Data was collected from Medline database, clinical-trial registry sites, and conference proceedings. This meta-analysis screened 78 studies. Quality of studies was assessed by New-Castle Ottawa scale. Heterogeneity and publication bias was checked by chi-square Q test and Eggers' test, respectively. Summary estimate of SVR12 and dropout rate was calculated at 95% confidence interval (CI). Results: Seven relevant clinical studies were identified. Two case-series and one case-report were excluded; only four studies were eligible for analysis. Three studies were cohort and one was retrospective-cohort in nature. Data was analyzed for 56 subjects. 33/56 subjects had cirrhosis. 39/56 subjects were on hemodialysis. 37/56 subjects were male. 30/56 subjects were treatment-naive. Pooled estimate of SVR12 was found 0.897 (CI 95%=0.957-0.772; p<0.01) and dropout estimate was 0.040 (CI 95%=0.011-0.137; p<0.01). Only one subject discontinued the treatment due to worsening Renal function regardless of ribavirin. Conclusion: This study concluded that combination of sofosbuvir and simeprevir, with or without ribavirin, was significantly effective and safe in HCV patients with severe CKD. For conclusive results, more data is required as this study involved only limited number of subjects.

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“…The summary estimate for sustained virological response (SVR) and dropout rate were 0.60 (95% CI, 0.47; 0.71) and 0.18 (95% CI, 0.08; 0.35), respectively [49]. Several studies have shown a better efficacy of PegIFN plus ribavirin than IFN monotherapy in patients on regular dialysis [50][51][52].…”

Section: Treatment Of Hcv Infection In Patients With Renal Diseasementioning

confidence: 98%

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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Antiviral therapy (pegylated interferon and ribavirin) of hepatitis C in dialysis patients: meta‐analysis of clinical studies

Cited by 64 publications

References 30 publications

Pegylated Interferon (Alone or With Ribavirin) for Chronic Hepatitis C in Haemodialysis Population

Pegylated Interferon (Alone or With Ribavirin) for Chronic Hepatitis C in Haemodialysis Population

Efficacy and Safety of Sofosbuvir with Simeprevir in Hepatitis C Infected Patients with Severe Chronic Kidney Disease: A Systematic Review and Meta-Analysis

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

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