Introduction
Treatment for patients with HCV-related liver diseases, CKD stage 5 with/without hemodialysis and having renal transplant prospect
Classification of chronic kidney disease (CKD)
DAAs | Target of DAAs | Metabolism | |||
---|---|---|---|---|---|
NS3/4A | NS5A | NS5B | Hepatic metabolism/metabolites | Renal excretion | |
Telaprevir | Yes | – | – | Yes | – |
Boceprevir | Yes | – | – | Yes | – |
Simeprevir | Yes | – | – | Yes | – |
Grazoprevir | Yes | – | – | Yes | – |
Asunaprevir | Yes | – | – | Yes | – |
Paritaprevir | Yes | – | – | Yes | – |
Glecaprevir | Yes | – | – | Yes | – |
Voxilaprevir | Yes | – | – | Yes | – |
Daclatasvir | – | Yes | – | Yes | – |
Ledipasvir | – | Yes | – | Yes | – |
Ombitasvir | – | Yes | – | Yes | – |
Elbasvir | – | Yes | – | Yes | – |
Pibrentasvir | – | Yes | – | Yes | – |
Velpatasvir | – | Yes | – | Yes | – |
Sofosbuvira | – | – | Yes | – | Yes |
Beclabuvir | – | – | Yes | Yes | – |
Ribavirinb | – | – | – | – | Yes |
Selection of DAAs in HCV-infected patients with severe renal impairment
Treatment with a 12-week combination of grazoprevir/elbasvir for patients with HCV GT1a, GT1b or GT4
Treatment with a pangenotypic combination of glecaprevir/pibrentasvir for 8–16 weeks
Treatment with a 24-week combination of asunaprevir/daclatasvir without ribavirin for HCV GT1b patients
Selection of DAAs in HCV-infected patients with mild renal impairment
Sofosbuvir-based regimens in patients with HCV and renal impairment
Ref. | GTs | No. of patients | CKD | Treatment-naïve/cirrhosis | Regimens | SVR12 |
---|---|---|---|---|---|---|
Taneja et al. [27] | GT1, 42 (65%); GT2, 1 (1%); GT3, 22 (34%) | 65 | eGFR < 30; HD, 54 (83%) | 55 (85%)/21 (32%) | 12- or 24-week of 200 mg SOF/60 mg DCV | 100% (65/65) |
Kumar et al. [28] | GT1a, 17; GT1b, 1; GT3a, 7; GT3b, 1 | 26 | CKD stage 4,5 or HD (eGFR < 30) | 19 (73%)/22 (85%) | 24-Week of generic SOF/RBV | 100% (26/26) |
Kumar et al. [28] | GT1a, 22; GT1b, 4 | 26 | CKD stage 4,5 or HD (eGFR < 30) | 23 (89%)/20 (77%) | 12-Week of generic SOF/LDV | 100% (26/26) |
Kumar et al. [28] | GT3a, 17; GT3b, 2 | 19 | CKD stage 4,5 or HD (eGFR < 30) | 16 (84%)/12 (63%) | 12-Week of generic SOF/DCV | 100% (19/19) |
Sho et al. [29] | GT2 | 40 | CKD stage 3a/3b | 29 (73%)/NA | 12-Week of SOF/RBV | 90% (36/40) |
Drug–drug interactions (DDIs) in patients with renal impairment
Conclusion
HCV GTs | Regimens | Treatment duration (weeks) | Grading of evidence and recommendations (disease status) |
---|---|---|---|
GT1a, GT1b, GT4 | Elbasvir (50 mg daily)/grazoprevir (100 mg daily) | 12 | A-1 (CKD 3b/4/5 or hemodialysis) |
All GTs | Glecaprevir (300 mg daily)/pibrentasvir (120 mg daily) | 8–16 | A-1 (CKD 3b/4/5 or hemodialysis) |
GT1b | Daclatasvir (60 mg daily)/asunaprevir (200 mg daily) | 24 | B-2 (CKD 3b/4/5 or hemodialysis) |
All GTs | Sofosbuvir (400 mg daily)/daclatasvir (60 mg daily) under close monitoring | 12 | B-2 (CKD 3b/4/5 or hemodialysis) |
GT1 | Sofosbuvir (400 mg daily)/ledipasvir (90 mg daily) under close monitoring | 12 | B-2 (CKD 3b/4/5 or hemodialysis) |
Regimens | APASL | EASL | AASLD-IDSA |
---|---|---|---|
Elbasvir/grazoprevir | A-1 [CKD 3b/4/5 or hemodialysis (GT1a, 1b, 4)] | A-1 [CKD 3b/4/5 or hemodialysis (GT1b)] | B-1 [CKD 3b/4/5 or hemodialysis (GT1a, 1b, 4)] |
Glecaprevir/pibrentasvir | A-1 [CKD 3b/4/5 or hemodialysis (all GTs)] | A-1 [CKD 3b/4/5 or hemodialysis (all GTs)] | B-1 [CKD 3b/4/5 or hemodialysis (all GTs)] |
Daclatasvir/asunaprevir | B-2 [CKD 3b/4/5 or hemodialysis (GT1b)] | No description | No description |
Sofosbuvir-based regimens | B-2 [CKD 4/5 or hemodialysis (all GTs)] | B-1 (alternative treatment) | Not recommendation and need close monitoring [41] |
Ritonavir-boosted paritaprevir/ombitasvir/dasabuvir | No description | A-1 [CKD 3b/4/5 or hemodialysis (GT1b)] | No description |