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Review
. 2016 Nov;9(6):887-897.
doi: 10.1177/1756283X16665254. Epub 2016 Sep 14.

Direct-acting antivirals for the treatment of chronic hepatitis C in patients with chronic kidney disease

Anita Kohli  1 , Ali Alshati  2 , Fawaz Georgie  2 , Richard Manch  2 , Robert G Gish  3
Affiliations
Review

Direct-acting antivirals for the treatment of chronic hepatitis C in patients with chronic kidney disease

Anita Kohli et al. Therap Adv Gastroenterol. 2016 Nov.

Abstract

All-oral, direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of chronic hepatitis C (CHC) treatment but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Our aim was to assess the efficacy and safety of DAAs for treatment of CKD patients. The National Library of Medicine through PubMed was searched for studies evaluating the efficacy of DAAs for the treatment of patients with CKD stages 4 or 5, as defined by the Kidney Disease Outcomes Quality Initiative guidelines [i.e. glomerular filtration rate (GFR) 15-29 ml/min per 1.73 m2 and GFR <15 ml/min per 1.73 m2, respectively, or hemodialysis or peritoneal dialysis]. Randomized clinical trials (RCTs) and relevant cohort studies were included if they were published in English and included sustained viral response after 12 weeks (SVR12) as a primary or secondary endpoint. After applying inclusion and exclusion criteria, eight studies (one RCT and seven cohort studies) following 350 patients were selected. For patients with CKD stage 4 or 5, ± hemodialysis, the overwhelming majority of DAA regimens were well-tolerated and resulted in SVR12 rates of 90-100%. Most studies were small, with the exception of one RCT evaluating elbasvir and grazoprevir. Overall, treatment of CHC in patients with CKD is highly effective with SVR12 rates similar to those seen in patients without CKD and with acceptable adverse event profiles. In patients with hepatitis C virus (HCV) genotype (GT) 1a, 1b or 4 and Stage 4 or 5 CKD, the best evidence available is for the use of elbasvir and grazoprevir. This combination as well as the combination of paritaprevir/ritonavir/ombitasvir/dasabuvir for HCV GT-1b are recommended. More studies are needed to assess efficacy and adverse effects of DAAs and their impact on CKD patients and to fully elucidate the effect of curing CHC on the natural history and sequelae of renal disease in CHC patients with CKD.

Keywords: chronic hepatitis C; chronic kidney disease; direct-acting antivirals; hemodialysis; hepatitis C virus.

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Conflict of interest statement

Dr Anita Kohli, MD has current activity with the scientific or clinical advisory boards of Gilead Sciences and Alexion Pharmaceuticals. Dr Kohli is a member of the Speakers Bureau and received honoraria from Merck & Co. Dr Ali Alshati, MD and Dr Fawaz Georgie, MD have no conflict of interest. Dr Richard Manch, MD has performed as a consultant or advisor to Gilead Sciences, AbbVie, Bristol-Myers Squibb, and Merck & Co. Dr Manch is a member of the Speakers Bureau for Gilead Sciences, AbbVie, Bristol-Myers Squibb, and Merck & Co. Dr Manch has had grants/research support from Gilead Sciences and AbbVie. Dr Robert G. Gish, MD has had grants/research support from AbbVie, Benitec Biopharma, Gilead Sciences, and Merck & Co. Dr Gish has performed as a consultant or advisor to AbbVie, Akshaya Pharmaceuticals, AstraZeneca, Bristol-Myers Squibb, Genentech, Gilead Sciences, Hoffman-LaRoche, Ltd., Ionis Pharmaceuticals, Janssen, Merck & Co., Nanogen Biopharmaceutical, and Presidio Pharmaceuticals. Dr Gish has current activity with the scientific or clinical advisory boards of AbbVie, AstraZeneca, Genentech, Gilead Sciences, Janssen, Merck & Co., and Nanogen Biopharmaceutical. Dr Gish is a member of the Speakers Bureau for AbbVie, Bristol-Myers Squibb, Gilead Sciences, and Merck. Dr Gish is a minor stock shareholder of Cocrystal Pharma.

Figures

Figure 1.
Figure 1.
Rates of SVR12 by regimen: data combined from all included trials. SVR12, sustained viral response after 12 weeks.
See this image and copyright information in PMC

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