Premium
Daclatasvir and reduced‐dose sofosbuvir: An effective and pangenotypic treatment for hepatitis C in patients with estimated glomerular filtration rate <30 mL/min
Author(s) -
Goel Amit,
Bhadauria Dharmendra S,
Kaul Anupma,
Verma Prashant,
Mehrotra Mayank,
Gupta Amit,
Sharma Raj K,
Rai Praveer,
Aggarwal Rakesh
Publication year - 2019
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.13222
Subject(s) - sofosbuvir , medicine , daclatasvir , renal function , gastroenterology , ribavirin , discontinuation , cirrhosis , hepatitis c , kidney disease , hepatitis c virus , virus , virology
Aim Sofosbuvir is a key agent for HCV treatment. It is not recommended for patients with chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) <30 mL/min. We report real‐life experience of treating a cohort of CKD patients with eGFR <30 mL/min using daclatasvir and half‐daily dose of sofosbuvir. Methods Adults patients who (i) had eGFR<30 mL/min and detectable HCV RNA and (ii) were treated with interferon and ribavirin free, DAA based regimens were included. All patients were treated with daily doses of daclatasvir 60 mg and sofosbuvir 200 mg. The planned duration of treatment was 12 weeks, except for 24 weeks in those with either clinical evidence of cirrhosis or on immunosuppressive drugs. The end‐points of the study were: (i) 12 weeks of follow‐up after treatment completion, (ii) treatment discontinuation, or (iii) death or loss to follow‐up. Results Thirty‐six (88%) among 41 included patients (median [range] age: 48 [19–75] years; 25 [61%] male; genotype 1/3/4 were 17/ 22/2; cirrhosis 5) completed the treatment, two discontinued and three died during treatment. On an intention‐to‐treat basis, HCV RNA were undetectable at 4 weeks of treatment, treatment completion and after 12 weeks of follow‐up in 40/41 (97.6%), 37/41 (90.2%) and 37/41 (90.2%), respectively. None of the patients had a relapse. Conclusions Daclatasvir and half‐daily dose of sofosbuvir was effective against genotype 1 and 3 HCV infection in patients with eGFR <30 mL/min. This combination could be a pangenotypic treatment option for such patients.