DAA-based antiviral treatment of patients with chronic hepatitis C in the pre- and postkidney transplantation setting
DAA-based antiviral treatment of patients with chronic hepatitis C in the pre- and postkidney transplantation setting
复制标题
DOI：
10.1111/tri.12799
复制
发表时间：
2016-09-01
影响因子：
3.1
通讯作者：
Maieron, Andreas
中科院分区：
文献类型：
--
作者：
Beinhardt, Sandra;Al Zoairy, Ramona;Maieron, Andreas
基于DAA的慢性丙型肝炎感染治疗方案鼓励治疗“难治性”队列。本研究调查了透析或肾移植或肝/肾移植后HCV患者中基于DAA的方案的有效性和安全性。评价了25例接受DAA联合治疗的患者：10例接受透析（8例：血液透析，2例：腹膜透析），8例为肾移植受者，7例为肝/肾移植受者。除了一名患者接受达卡他韦（[DCV]/60 mg/QD）/西米普韦（[SMV]/150 mg/QD）治疗外，其他患者接受基于索非布韦的方案（[SOF]; 400 mg/QD）联合SMV：8，DCV：13或ledipasvir（[LDV] 90 mg/QD），利巴韦林（[RBV];基于体重）或聚乙二醇干扰素/RBV。通过Abbott RealTime（LLOQ：12 IU/ml）或Roche AmpliPrep/COBAS TaqMan检测试剂盒（LLOQ：15 IU/ml）测定HCV-RNA;每4周一次、治疗结束时以及此后4周和12周评价治疗反应。24例（96%）患者达到SVR 12/24（ITT分析）。平均治疗持续时间为15.1 +/- 5.1周（+/- SD），2例患者提前终止-均达到SVR 12。6例患者因基础疾病并发症住院。1例患者达到SVR 24，但再次感染（第27周）。肾功能保持稳定;仅1例患者的血清肌酐升高- SOF降至400 mg/48 h。DAA联合治疗肾功能受损的HCV患者非常有效，耐受性良好。这些发现需要进一步的对照试验和来自现实生活队列的数据。
DAA-based regimens for chronic hepatitis C infection encourage treatment of "difficult-to-treat" cohorts. This study investigated efficacy and safety of DAA-based regimens in HCV patients on dialysis or postkidney or liver/kidney transplantation. Twenty-five patients treated with DAA combinations were evaluated: 10 were on dialysis (eight: hemodialysis, two: peritoneal dialysis), eight were kidney transplant recipients, and seven were liver/kidney transplant recipients. Except for one patient treated with daclatasvir ([DCV]/60 mg/QD)/simeprevir ([SMV]/150 mg/QD), the others received sofosbuvir-based regimens ([SOF]; 400 mg/QD) combined with SMV: eight, DCV: 13 or either ledipasvir ([LDV] 90 mg/QD), ribavirin ([RBV]; weight based) or pegylated interferon/RBV. HCV-RNA was determined by Abbott RealTime (LLOQ]: 12 IU/ml) or Roche AmpliPrep/COBAS TaqMan assay (LLOQ: 15 IU/ml); treatment response evaluated every 4 weeks, at the end of treatment, and 4 and 12 weeks thereafter. Twenty-four (96%) patients achieved SVR 12/24 (ITT-analysis). Mean treatment duration was 15.1 +/- 5.1 weeks (+/- SD), and two patients terminated prematurely - both reached SVR12. Six patients were hospitalized due to complications of underlying disease. One patient achieved SVR24 but was re-infected (week 27). Kidney function remained stable; serum creatinine increased in only one patient - SOF was reduced to 400 mg/48 h. Treatment with DAA combinations in renally impaired HCV patients is highly effective and well tolerated. These findings call for further controlled trials and data from real-life cohorts.