Managing hepatitis C therapy failures and chronic kidney disease

Research output: Contribution to journalArticle

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Abstract

INTRODUCTION: Hepatitis C virus (HCV) infection leads to important morbidity and mortality through liver disease and extra-hepatic manifestations. Recent evidence suggests the role of HCV in developing chronic kidney disease (CKD); also, HCV adversely affects cardiovascular (CV) disease both in the general population and in patients with CKD. Areas covered: All-oral, interferon-free direct-acting antiviral agents (DAAs) are currently available; anti-HCV regimens based on DAAs are provided with high efficacy and safety and short treatment duration. However, some difficult-to-treat populations still exist including patients with CKD and those who failed previous DAA regimen. Expert commentary: Two DAAs regimens (elbasvir/grazoprevir and glecaprevir/pibrentasvir) are now recommended for the treatment of HCV in patients with advanced CKD, these combinations have shown great efficacy, according to two multicenter phase-3 trials (C-SURFER and EXPEDITION-4). These trials reported a minimal impact of baseline resistance-associated substitutions (RASs) on treatment outcomes. The sofosbuvir/velpatasvir/voxaliprevir combination has been recommended as the first-line option for DAAs failures, on the basis of the results given by two randomized clinical trials involving patients who had been previously received DAA-containing regimens (POLARIS 1-4 studies). It has been suggested that clinicians should consider RASs upon the introduction of DAA-based antiviral therapy.

Original languageEnglish
Pages (from-to)1135-1142
Number of pages8
JournalExpert Review of Clinical Pharmacology
Volume11
Issue number11
DOIs
Publication statusPublished - Nov 1 2018

Fingerprint

Hepatitis C
Chronic Renal Insufficiency
Antiviral Agents
Hepacivirus
Therapeutics
Virus Diseases
Interferons
Population
Liver Diseases
Cardiovascular Diseases
Randomized Controlled Trials
Morbidity
Safety
Mortality
Liver

Keywords

  • Chronic kidney disease
  • DAA failures
  • direct-acting antivirals
  • hepatitis C virus

ASJC Scopus subject areas

  • Pharmacology, Toxicology and Pharmaceutics(all)
  • Pharmacology (medical)

Cite this

Managing hepatitis C therapy failures and chronic kidney disease. / Fabrizi, Fabrizio; Messa, Piergiorgio.

In: Expert Review of Clinical Pharmacology, Vol. 11, No. 11, 01.11.2018, p. 1135-1142.

Research output: Contribution to journalArticle

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