Efficacy and safety of ribavirin therapy for chronic hepatitis E after kidney transplantation

Yoshida, Tomoaki; Takamura, Masaaki; Goto, Ryo; Takeuchi, Suguru; Tsuchiya, Atsunori; Kamimura, Kenya; Tasaki, Masayuki; Nakagawa, Yuki; Saito, Kazuhide; Tomita, Yoshihiko; Terai, Shuji

doi:10.1111/hepr.13363

Cited by 7 publications

(12 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this sense, clinical guidelines recommend a program therapy duration of 12 weeks using RBV at the initiation with a weight-adjusted dose or a dose adjusted on the basis of the estimated glomerular filtration rate [12,13,23]. Following these recommendations, a total of 176 transplant patients have been reported, and 129 of these patients have achieved SVR (73.2%) [11,[24][25][26][27][28][29][30][31][32][33]. Therefore, this recommendation seems to be highly effective for the treatment of HEV infection in transplant recipients infected by genotype 3 HEV.…”

Section: Discussionmentioning

confidence: 99%

Ribavirin as a First Treatment Approach for Hepatitis E Virus Infection in Transplant Recipient Patients

et al. 2019

View full text Add to dashboard Cite

The hepatitis E virus (HEV) is the major cause of acute hepatitis of viral origin worldwide. Despite its usual course as an asymptomatic self-limited hepatitis, there are highly susceptible populations, such as those with underlying immunosuppression, which could develop chronic hepatitis. In this situation, implementation of therapy is mandatory in the sense to facilitate viral clearance. Currently, there are no specific drugs approved for HEV infection, but ribavirin (RBV), the drug of choice, is used for off-label treatment. Here, we present two cases of chronic HEV infection in transplant patients, reviewing and discussing the therapeutic approach available in the literature. The use of RBV for the treatment of an HEV infection in organ transplant patients seems to be effective. The recommendation of 12 weeks of therapy is adequate in terms of efficacy. Nevertheless, there are important issues that urgently need to be assessed, such as optimal duration of therapy and drug dosage.

show abstract

Section: Discussionmentioning

confidence: 99%

Ribavirin as a First Treatment Approach for Hepatitis E Virus Infection in Transplant Recipient Patients

et al. 2019

View full text Add to dashboard Cite

show abstract

“…This finding is in line with previous observations, showing more than 80% of viral clearance after 3 months of antiviral treatment with ribavirin. 2,8,9 Previous studies already identified risk factors for treatment failure of chronic HEV infection. Immunosuppressive therapy with tacrolimus instead of cyclosporine A 6 and a low lymphocyte count at therapy initiation 7 have been shown to be associated with a decreased response to therapy.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…6 In the absence of spontaneous clearance, the treatment option of choice is ribavirin, 7 resulting in HEV clearance after 3 months in up to 78%-100% of patients. 4,7,8 However, ribavirin therapy carries the risk of adverse effects, such as anemia due to bone marrow toxicity. 7,9 The appropriate treatment of HEV infection in immunosuppressed patients remains controversial, mostly due to the lack of controlled trials and overall small numbers of cases.…”

Section: Introductionmentioning

confidence: 99%

“…According to the literature, up to 30% of HEV‐infected patients show a spontaneous clearance of HEV after reduction of immunosuppression at a follow up of 6 months 6 . In the absence of spontaneous clearance, the treatment option of choice is ribavirin, 7 resulting in HEV clearance after 3 months in up to 78%–100% of patients 4,7,8 . However, ribavirin therapy carries the risk of adverse effects, such as anemia due to bone marrow toxicity 7,9 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Monitoring of hepatitis E virus RNA during treatment for chronic hepatitis E virus infection after renal transplantation

Affeldt

Cristanziano

Grundmann

et al. 2021

Immunity Inflam & Disease

View full text Add to dashboard Cite

Background Recently, chronic hepatitis E virus (HEV) infections gained increasing attention as a possible cause for elevated liver enzymes of unknown origin and liver cirrhosis in solid organ transplant recipients. Reduction of immunosuppressive therapy and/or use of antiviral drug ribavirin have been established as possible treatment strategies. Methods The efficacy of dose reduction of mycophenolic acid (MPA) and ribavirin therapy was retrospectively analyzed in eight renal transplant patients of our outpatient clinic who were diagnosed with HEV infection by detection of specific antibodies (immunoglobulin M and immunoglobulin G) and/or positive RNA in blood and stool. In four patients serial HEV viral loads in blood were measured. Results Only one patient reached HEV clearance after reduction of immunosuppressive therapy (predominantly reduction of MPA daily dose) alone, whereas six patients were treated with ribavirin after reduction of immunosuppressive therapy due to persistent virus replication. Four of six patients reached HEV clearance after 3 months of ribavirin therapy. HEV clearance was observed after 34–42 days. Two patients, both treated with rituximab within the last 12 months before diagnosis of HEV infection, needed prolonged ribavirin therapy due to persistent viral replication. Conclusion Reduction of daily dose of MPA therapy alone in transplant patients with chronic HEV infection may not be sufficient to control viral replication. HEV clearance under ribavirin therapy shows interindividual variability. Therefore, serial viral monitoring may be useful to personalize treatment duration. Rituximab therapy is a risk factor for complicated‐to‐treat chronic HEV infection.

show abstract

“…The initial management for chronic infection is to reduce immunosuppressive therapy leading to the elimination of HEV in approximately 30% of patients . Alternatively, treatment with ribavirin (RBV) is effective . Recently, several mutations of HEV were detected in RBV treatment failure patients .…”

Section: Introductionmentioning

confidence: 99%

Time course alterations of virus sequences and immunoglobulin titers in a chronic hepatitis E patient

Nitta

Takahashi²,

Kawai‐Kitahata

et al. 2020

Hepatology Research

View full text Add to dashboard Cite

Aim: Hepatitis E virus (HEV) can cause chronic infection in immunocompromised hosts. However, the dynamics of HEV during persistent infection is not well understood. To elucidate time course alterations in virus sequences and anti-HEV antibodies during persistent infection, we analyzed the HEV sequences and titers of anti-HEV antibodies from a chronic hepatitis E patient.Methods: Serum samples were obtained from a chronic hepatitis E patient under corticosteroid therapy for neurological disease. The titers of anti-HEV antibodies (immunoglobulin A, immunoglobulin M, and immunoglobulin G) in serum samples were detected by enzyme immunoassay. The full or near-full nucleotide sequences of HEV isolated from consecutive serum samples were identified and compared. Phylogenetic analysis was also performed.Results: Alterations of anti-HEV antibodies from a chronic hepatitis E patient were different from those previously reported in acute hepatitis E patients. The virus sequence was unchanged in the period without treatment, but nucleotide mutations were observed after ribavirin treatment was started. In addition, the sequence of this strain had extremely high identity to that isolated from swine liver in Japan.Conclusions: Virus mutations in HEV emerged after ribavirin treatment was started. Sequence analysis may useful for deciding the treatment strategy for chronic hepatitis E patients who did not eliminate the virus with 3 months of RBV treatment and inferring the origin of the infection. This report provides insights into the chronicity of hepatitis E, and the impact of persistent infection and ribavirin treatment on the emergence of virus mutations.

show abstract

Efficacy and safety of ribavirin therapy for chronic hepatitis E after kidney transplantation

Cited by 7 publications

References 30 publications

Ribavirin as a First Treatment Approach for Hepatitis E Virus Infection in Transplant Recipient Patients

Ribavirin as a First Treatment Approach for Hepatitis E Virus Infection in Transplant Recipient Patients

Monitoring of hepatitis E virus RNA during treatment for chronic hepatitis E virus infection after renal transplantation

Time course alterations of virus sequences and immunoglobulin titers in a chronic hepatitis E patient

Contact Info

Product

Resources

About