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

Abstract

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.

Sofosbuvir‐based treatment is safe and effective in Indian hepatitis C patients on maintenance haemodialysis: A retrospective study

“…Sustained virologic response (SVR) rates with peg‐IFN monotherapy (approximately 40%) in HCV‐infected patients were slightly greater than those with conventional interferon therapy (approximately 30%). The addition of ribavirin did not result in better SVR rates than those associated with the use of peg‐IFN alone . However, interferon and ribavirin are associated with significant toxicity, including influenza‐like symptoms, anaemia, and depression .…”

“…Earlier studies suggested that antiviral therapy for chronic hepatitis C with PEGylated interferon (peg‐IFN) alone or with ribavirin (rib) was less effective and accompanied by numerous side‐effects that led to increased safety concerns . Sustained virologic response (SVR) rates with peg‐IFN monotherapy (approximately 40%) in HCV‐infected patients were slightly greater than those with conventional interferon therapy (approximately 30%).…”

Universal Sustained Viral Response to the Combination of Ombitasvir/Paritaprevir/Ritonavir and Dasabuvir with/without Ribavirin in Patients on Hemodialysis Infected with Hepatitis C Virus Genotypes 1 and 4

“…At the beginning of the century, a combination of pegylated interferon and ribavirin became the standard treatment for HCV [11,12,13]. However, adverse effects of treatment with interferon and ribavirin in patients with chronic kidney disease (CKD) and the resulting poor outcomes [13] have greatly restricted widespread use of this combination.…”

Successful treatment of chronic hepatitis C in a hemodialysis

“…Few Serbian hemodialysis patients were treated with these medications, with modest results, so the majority remains treatment naïve. Interferon based therapy is neither effective (a SVR rate of 40-58%) nor safe (a 26.9% withdrawal rate due to side-effects) in patients with end stage renal disease (ESRD) [17,18]. Sofosbuvir / ledipasvir, grazoprevir / elbasvir and 3D regimen were approved for clinical use in Serbia during 2016/17.…”