Anti-viral therapy in haemodialysed HCV patients: efficacy, tolerance and treatment strategy.

Details

Serval ID
serval:BIB_90D147FBC172
Type
Article: article from journal or magazin.
Collection
Publications
Title
Anti-viral therapy in haemodialysed HCV patients: efficacy, tolerance and treatment strategy.
Journal
Alimentary Pharmacology and Therapeutics
Author(s)
Deltenre P., Moreno C., Tran A., Ollivier I., Provôt F., Stanke F., Lazrek M., Castel H., Canva V., Louvet A., Colin M., Glowacki F., Dharancy S., Henrion J., Hazzan M., Noel C., Mathurin P.
ISSN
1365-2036 (Electronic)
ISSN-L
0269-2813
Publication state
Published
Issued date
2011
Volume
34
Number
4
Pages
454-461
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
BACKGROUND: In end-stage renal disease (ESRD) patients, hepatitis C virus (HCV) eradication improves patient and graft survival.
AIM: To determine optimal use of erythropoietin (EPO) and ribavirin, to compare ribavirin concentrations with those of HCV patients having normal renal function and to evaluate sustained virological response (SVR) in a prospective observatory of ESRD candidates for renal transplantation.
METHODS: Thirty-two naïve patients were treated with Peg-IFN-α2a and ribavirin. Two different schedules of ribavirin and EPO administration were used: starting ribavirin at 600mg per week and adapting EPO when haemoglobin (Hb) fell below 10g/dL (adaptive strategy) or starting ribavirin at 1000mg per week while increasing EPO from the start of treatment (preventive strategy).
RESULTS: Patients treated with the adaptive strategy had lower median Hb levels (9.6 vs. 10.9g/dL, P=0.02) and more frequent median Hb levels below 10g/dL (58 vs. 5%, P=0.0007) despite lower median ribavirin doses (105 vs. 142mg/day, P<0.0001) than patients treated with the preventive strategy. There was a trend for more frequent transfusion in patients treated with the adaptive strategy than in patients treated with preventive strategy (50 vs. 20%, P=0.08). Compared to patients with normal renal function, ESRD patients had lower ribavirin concentrations during the first month (0.81 vs. 1.7mg/L, P=0.007) and similar concentrations thereafter. SVR was reached in 50%.
CONCLUSIONS: Pegylated interferon (Peg-IFN) and an adapted schedule of ribavirin are effective in ESRD patients. Increasing EPO from the start of treatment provides better haematological tolerance. The optimal dosage of ribavirin remains unresolved, in light of frequent side effects.
Keywords
Adult, Antiviral Agents/administration & dosage, Antiviral Agents/adverse effects, Dose-Response Relationship, Drug, Drug Therapy, Combination, Female, Follow-Up Studies, Hepatitis C, Chronic/drug therapy, Humans, Interferon-alpha/administration & dosage, Interferon-alpha/adverse effects, Kidney Failure, Chronic/therapy, Kidney Transplantation, Male, Middle Aged, Polyethylene Glycols/administration & dosage, Polyethylene Glycols/adverse effects, Recombinant Proteins, Renal Dialysis, Ribavirin/administration & dosage, Ribavirin/adverse effects, Time Factors, Treatment Outcome, Viral Load
Pubmed
Web of science
Create date
06/12/2013 10:09
Last modification date
20/08/2019 14:54
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