Although the advent of direct acting antivirals in the management of HCV are evolving such that they do not use interferons, technically these are not indicated for patients with renal failure, due to lack of clearance of metabolites. What experience is there in using them to clear HCV in patients awaiting kidney transplantation? Are these metabolites cleared by hemodialysis? There is a pilot study of sofosbuvir and ribavirin in genotype 1 or 3 hepatitis C virus infected patients who have chronic renal insufficiency (http://clinicaltrials.gov/ct2/show/NCT01958281?term=sofosbuvir+kidney&rank=1).
From what I know it seems that a lot of attention is being paid to the different new drugs that are becoming available either off label or following regulatory approval to try and guage which of them are safest to use in the dialysis population. This may require that there be more data made available. The following information of course acts as a barrier to usage currently http://hcvguidelines.org/full-report/unique-patient-populations-renal-impairment-box-summary-recommendations-patients-renal
Because of lack of data, no dose recommendation can be given for patients with severe renal impairment (eGFR)
Hi
Kidney transplanted patients with HVC were treated succesfully with Adacolumn Leukocyte Apheresis (OtzukaElectronics, Japan) .
This might be an option for ESRD patients also, although I am not aware of such publications. Nevertheless it could be a cost effective therapy option when compared to the new emerged anti HCV drugs.
I think there is no real hard data for recommendations as the jury in out in different phases of clinical trials with the new(er) direct acting antivirals. Another trial still recruiting may give more information re which of these could be a better choice to pursue.
http://clinicaltrial.gov/ct2/show/NCT02108639?term=hepatitis+C+and+renal+failure&recr=Open&rank=8
We did treat (SOF + Simeprevir) one patient with 3/6 fibrosis post SLK transplant who also had ESRD and developed liver and renal failure. The viral count came down to 3k within a week but it was a case of too little too late. He passed away. It would be great to know if others have used this off label ?
The COSMOS study used this combination in cirrhotics, presented at EASL in April, but nothing published or presented in post-liver transplant patients. I spoke with Norah Terrault at UCSF and it appears they have experience with this combination post-transplant.
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Infectious Diseases