Higher risk of renal disease in chronic hepatitis C patients: Antiviral therapy survival benefit in patients on hemodialysis

Söderholm, Jonas; Millbourn, Charlotta; Büsch, Katharina; Kövamees, Jan; Schvarcz, Robert; Lindahl, Karin; Bruchfeld, Annette

doi:10.1016/j.jhep.2017.12.003

Cited by 44 publications

(33 citation statements)

References 38 publications

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“…One thing worth mentioning in the context of economic burden of HCV is the emergence of the direct‐antiviral agents (DAAs) for treatment of the infection. Indeed, treatment of HCV with DAA has evolved rapidly over the last 5 years and shows promising results in efficacy, safety and maintaining SVR . Advocating treatment of HCV with DAAs in more and more people might lead to eradication of HCV globally, thus creating a significant positive impact on mortality and healthcare resource utilization, including that in patients with ESRD …”

Section: Discussionmentioning

confidence: 99%

Prevalence, mortality and healthcare utilization among Medicare beneficiaries with Hepatitis C in Haemodialysis units

Deshpande

Stepanova

Golabi

et al. 2019

Journal of Viral Hepatitis

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Hepatitis C (HCV) is more common among patients with end-stage renal disease requiring haemodialysis compared to the general population. Thus, we aimed to assess trends in prevalence, health resource utilization and mortality among Medicare beneficiaries with HCV on haemodialysis. This is a retrospective study of outpatient and inpatient claims for Medicare beneficiaries receiving haemodialysis (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016).A total of 291 663 subjects on haemodialysis were included (67.3 ± 15.2 years, 55% male, 55% white, 49% age-based eligibility). The prevalence of HCV in subjects on haemodialysis was stable and was significantly higher (mean 4.2% in 2005-2016, P = 0.50 for the trend) than in subjects not on haemodialysis (<1%). In multivariate analysis, liver cirrhosis (odds ratio = 3.4 (95% CI = 3.3-3.6)) was an independent predictor of 1-year mortality among haemodialysis patients. Mean total inpatient payments in dialysis patients with HCV remained stable during 2005 ($73 803) through 2016 ($72 133) (trend P = 0.54) while mean total outpatient payment decreased from 2005 ($53 497) to 2016 ($35 439; trend P = 0.0013). In multivariate analysis, after adjustment for age, gender, race and location, both HCV and cirrhosis remained significant contributors to greater spending [HCV: inpatient

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Section: Discussionmentioning

confidence: 99%

Prevalence, mortality and healthcare utilization among Medicare beneficiaries with Hepatitis C in Haemodialysis units

Deshpande

Stepanova

Golabi

et al. 2019

Journal of Viral Hepatitis

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“…Another study showed that HCV infection is an independent risk factor for developing end‐stage renal disease and that the cumulative rate of end‐stage renal disease is high in patients with HCV infection . Furthermore, treatment of hemodialysis patients with chronic HCV infection provides significant survival advantage, and the survival rate of post‐renal transplantation patients treated for HCV is significantly higher than their counterparts who had not been treated for HCV . Several other studies reported the effectiveness of 24‐week daclatasvir and asunaprevir combination therapy in chronic hemodialysis patients with HCV infection .…”

Section: Discussionmentioning

confidence: 99%

“…17 Furthermore, treatment of hemodialysis patients with chronic HCV infection provides significant survival advantage, and the survival rate of post-renal transplantation patients treated for HCV is significantly higher than their counterparts who had not been treated for HCV. 18 Several other studies reported the effectiveness of 24-week daclatasvir and asunaprevir combination therapy in chronic hemodialysis patients with HCV infection. 19,20 Although previous clinical trials documented the effectiveness of EBR/GZR in patients with severe renal dysfunction (CKD 4-5), 5 to our knowledge there is no information on the effect of the same treatment in patients with severe renal function in daily clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of elbasvir plus grazoprevir combination therapy in Japanese patients infected with hepatitis C virus genotype 1b

Takeuchi

Akuta

Sezaki

et al. 2018

Hepatology Research

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Aim Treatment with all‐oral direct‐acting antiviral agents (DAAs) elbasvir/grazoprevir (EBR/GZR) is associated with high sustained virologic response (SVR). The aim of this study was to evaluate the safety and treatment efficacy of EBR/GZR in hepatitis C virus (HCV)‐infected patients. Methods This retrospective cohort study included 147 consecutive patients with chronic HCV genotype 1b infection who were treated with EBR (50 mg) plus GZR (100 mg) once daily for 12 weeks. The rates of SVR at 12 weeks after the end of treatment (SVR12) were evaluated based on patient baseline characteristics. Treatment efficacy was analyzed according to background chronic kidney disease (CKD), and retreatment efficacy in patients who failed to respond to previous DAAs. Results The SVR12 was 94% (138 of 147 patients), based on intention‐to‐treat analysis. Rates of SVR12 were 97% (131 of 135) and 58% (7 of 12) in cases naïve to DAA treatment and failure to respond to prior DAAs, respectively. The SVR12 rates in patients with CKD stage 4–5 was 100% (8 of 8). All patients (4 of 4 patients) with stage 4–5 and advanced fibrosis (Fibrosis‐4 index ≥3.25) also achieved SVR12. Multivariate analysis that included the above variables identified pretreatment with other DAAs as an independent factor that was significantly and independently associated with non‐SVR12 (odds ratio, 97.5; P < 0.001). Relapsers of first DAAs, excluding the combination of ledipasvir and sofosbuvir, achieved SVR12. Characteristic novel non‐structural protein 5A substitutions were not detected after failure of retreatment with EBR/GZR. Conclusion Treatment with EBR/GZR was highly efficacious with acceptable safety, even in patients with CKD stage 4–5. Retreatment of relapsers to prior DAAs, excluding ledipasvir and sofosbuvir, achieved SVR12.

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“…Patients with hepatocellular carcinoma and relatively low Model for End‐Stage Liver Disease (MELD) scores did better with deferred therapy with the option of receiving an HCV viremic organ earlier . Although not modeled specifically, kidney disease patients with significant residual function not yet on dialysis should have reduced rates of progression to ESRD with DAA treatment and may potentially benefit more from early intervention …”

Section: Discussionmentioning

confidence: 99%

Hepatitis C virus–infected kidney waitlist patients: Treat now or treat later?

Kiberd

Doucette

Vinson

et al. 2018

American Journal of Transplantation

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Currently many but not all centers transplant hepatitis C virus (HCV) viremic positive (+) donor kidneys into HCV+ recipients. Directed donation of HCV+ organs reduces the wait time to transplantation for HCV+ patients. Direct-acting antiviral (DAA) therapy can cure HCV in virtually all who are infected. Some have suggested that treatment of HCV+ waitlisted patients be deferred with the hope that earlier transplantation will provide better outcomes than early DAA therapy. However, there are not enough organs to guarantee prompt transplantation for the current waitlist of infected candidates. A Markov medical decision analysis model was created to compare the overall outcomes of delayed DAA therapy (Option 1) to immediate DAA therapy (Option 2) in waitlisted HCV+ patients. Option 1 patients were modeled to be transplanted 1 year earlier, with a higher cumulative transplant incidence (54% at 5 years post-listing vs 45% for Option 2). Despite this, Option 2 provided 0.43 (95% confidence interval [CI] 0.38-0.49) more life years than Option 1. However, Option 1 was preferred for regions with much greater access to HCV+ organs or in patients with very low HCV+-associated mortality. The best option from an individual patient's perspective will differ by region and candidate.

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Higher risk of renal disease in chronic hepatitis C patients: Antiviral therapy survival benefit in patients on hemodialysis

Cited by 44 publications

References 38 publications

Prevalence, mortality and healthcare utilization among Medicare beneficiaries with Hepatitis C in Haemodialysis units

Prevalence, mortality and healthcare utilization among Medicare beneficiaries with Hepatitis C in Haemodialysis units

Efficacy and safety of elbasvir plus grazoprevir combination therapy in Japanese patients infected with hepatitis C virus genotype 1b

Hepatitis C virus–infected kidney waitlist patients: Treat now or treat later?

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