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Safety and effectiveness of response‐guided therapy using pegylated interferon and ribavirin for chronic hepatitis C virus infection in patients on maintenance dialysis
Author(s) -
Goel Amit,
Bhadauria Dharmendra Singh,
Kaul Anupma,
Prasad Narayan,
Gupta Amit,
Sharma Raj Kumar,
Rai Praveer,
Aggarwal Rakesh
Publication year - 2017
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12833
Subject(s) - ribavirin , medicine , pegylated interferon , dialysis , gastroenterology , interferon , hepatitis c virus , hepatitis c , immunology , virus
Aim Treatment of hepatitis C virus (HCV) infection in patients with end‐stage renal disease (ESRD) is difficult. Addition of ribavirin to pegylated‐interferon (Peg‐IFN) may help to improve the treatment response. Further, treatment duration could be shortened using a response‐guided treatment (RGT) approach. Methods We retrospectively reviewed records of treatment‐naïve adult patients with ESRD and chronic HCV infection who had been treated with Peg‐IFN and low‐dose ribavirin using a RGT approach. Rapid responders (undetectable HCV‐RNA at 4 weeks) received treatment for 12 weeks, and slow responders (HCV‐RNA detectable at 4 weeks, but undetectable or with >2.0 log 10 reduction at week 12) for 24 (genotype 3; GT3) or 48 (genotype 1; GT1) weeks. In those without such reduction (null responders), treatment was discontinued. Results Of 26 non‐cirrhotic patients (GT1 15, GT3 11) treated, four (15%; GT1 3, GT3 1) were null responders. Twenty‐two (85%) patients had either rapid ( n = 14 (54%); GT1 10, GT3 4) or slow response ( n = 8 (31%); GT1 2, GT3 6). Of them, 21 patients had undetectable RNA at the end of treatment; one could not complete the treatment and was lost thereafter. There were no deaths during treatment. Three patients relapsed and three others died in 6 months after stopping treatment. Overall, 15/26 (58%) patients attained SVR24. Fourteen patients underwent transplantation beginning one month after treatment completion, and all were relapse‐free after 17 (14–24) months of follow‐up. Conclusion RGT using Peg‐IFN and ribavirin was effective in ESRD patients on maintenance dialysis. Renal transplant was safely done within one month of completing such treatment.