The outcome of Daclatasvir and low dose Sofosbuvir therapy in end-stage renal disease patients with hepatitis C virus infection

Abstract

Rapid progression of chronic kidney disease (CKD) is seen in patients with hepatitis C virus (HCV) infection compared with uninfected patients. Despite the high efficacy of direct-acting antivirals (DAAVs), their cost represents a limiting factor to their use in developing countries.
 Aim. This study aimed to evaluate the efficacy of low dose Sofosbuvir along with Daclatasvir in the management of HCV infection in end-stage renal disease (ESRD) patients.
 Methods. A total of 82 HCV positive patients on ESRD were included in this study. The patients were observed for six months without antiviral drugs. Patients who remained seropositive were divided into two groups. The first group included 26 (37%) patients who were treated with half-dose Sofosbuvir 200 mg and Daclatasvir 60 mg and the second group consisted of 44 (63%) patients who have been treated with full-dose Sofosbuvir 400 mg and Velpatasvir 100 mg irrespective of HCV infection genotype for 12 weeks also.
 Results. 12 (14%) patients became seronegative spontaneously. All patients (100%) of both groups achieved sustained virological response with undetectable HCV RNA in 12 weeks of the treatment. There were nonsignificant gastrointestinal side effects in the full dose Sofosbuvir group. All patients tolerated the DAAs well. No patient discontinued antiviral therapy due to side effects
 Conclusion. In this study, the spontaneous seroconversion of HCV was 14%. Low-dose Sofosbuvir along with Daclatasvir was safe and as effective as full-dose Sofosbuvir and Velpatasvir in the treatment of HCV in ESRD patients. Low-dose Sofosbuvir regimen can be recommended for HCV infection treatment in ESRD patients.

Sofosbuvir plus velpatasvir combination for the treatment of chronic hepatitis C in patients with end stage renal disease on renal replacement therapy: A systematic review and meta‐analysis

“…A total of seven studies satisfied our pre-defined selection criteria and were included in the meta-analysis. 4,[17][18][19][20][21][22] The flow diagram for the search strategy is shown in Figure 1.…”

“…The seven studies that were finally incorporated in the meta-analysis included four single-centre studies (3 from India and 1 from Bangladesh) and three multicentric studies. 4,[17][18][19][20][21][22] One of the multicentric studies was conducted across 22 centres in Europe, North America and Australia, another was conducted in 18 haemodialysis centres of 3 Taiwanese cities, and the third study was conducted in 15 academic centres of Taiwan. 4,21,22 Five of the studies were prospective while the studies by Gaur et al and Liu et al were retrospective.…”

“…4,21,22 Five of the studies were prospective while the studies by Gaur et al and Liu et al were retrospective. 4,[17][18][19][20][21][22] All the studies were published between 2019 and 2021. Modified NOS score was ≥5 for all the included studies.…”

“…In all the studies, the fixed-dose combination of 400 mg of SOF and 100 mg of VEL was given daily for 12 weeks. 4,[17][18][19][20][21][22] Majority of the patients were on maintenance haemodialysis (98.05%) and only 8 (1.95%) patients were on peritoneal dialysis. 4,[17][18][19][20][21][22] Data about gender were extractable in 246 patients, of whom 151 (61.4%) were males.…”

“…4,[17][18][19][20][21][22] Majority of the patients were on maintenance haemodialysis (98.05%) and only 8 (1.95%) patients were on peritoneal dialysis. 4,[17][18][19][20][21][22] Data about gender were extractable in 246 patients, of whom 151 (61.4%) were males. 4,17,18,21 Details of prior treatment history was present in 293 patients, among whom 21 (7.2%) patients had previous treatment exposure while 272 (92.8%) patients were treatment naïve.…”