Elbasvir/grazoprevir administered for 12 weeks via percutaneous endoscopic gastrostomy tube achieves sustained virologic response: A case report and a review of the literature

Abstract

Enteral tubes are necessary for certain patients; however, medication absorption can be affected by this route of administration potentially resulting in decreased efficacy. All first-line treatments for Hepatitis C Virus (HCV) infection are only available as tablets and may have decreased absorption if administered via an enteral tube.This report describes the first case of a pegylated interferon and ribavirin treatmentexperienced patient who successfully achieved HCV cure after 12 weeks of elbasvir/ grazoprevir administered via percutaneous gastrostomy tube. We further review the available pharmacokinetic and clinical literature regarding administration via enteral feeding tubes for all first-line direct-acting antivirals (DAAs). The literature suggests that crushed administration can be considered for DAAs in patients with gastric access. However, caution should be exercised in patients with extragastric enteral tubes and in those with altered gastrointestinal tract anatomy.

Crushing and Splitting Direct-Acting Antivirals for Hepatitis C Virus Treatment: A Case Series and Literature Review

“…Three additional cases of treatment with ledipasvir/sofosbuvir in HCV genotype 1 patients with oral administration after crushing and splitting tablets are newly reported here. Additional published case reports include 2 patients with genotype 1a HCV treated with elbasvir/grazoprevir [ 14 , 24 ] and a genotype 1b patient treated with glecaprevir/pibrentasvir [ 15 ]; all patients achieved SVR 12 [ 14 , 15 , 24 ].…”