New and Emerging Evidence on the Use of Second-Generation Direct Acting Antivirals for the Treatment of Hepatitis C Virus in Renal Impairment

Journal of Pharmacy Practice
Maria A SorberaRebecca Cope

Abstract

Due to the intimate relationship between liver and kidney disease in hepatitis C virus (HCV) infection, treatment options for HCV-positive patients at any stage of chronic kidney disease (CKD) are essential. The availability of second-generation, direct-acting antiviral (DAA) combinations has allowed for the advent of interferon-sparing treatment regimens with shorter durations and minimal side effects. While many of the second-generation DAAs are principally metabolized by the hepatic system, dosing in severe renal impairment (creatinine clearance [CrCl] <30 mL/min) or dialysis has remained questionable due to limited experience. New evidence regarding the use of these agents in renal impairment continues to become available, as real-world experience with these treatment regimens is reported. Simeprevir, ledipasvir, paritaprevir, ombitasvir, dasabuvir, and daclatasvir have data to suggest safety in end-stage renal disease. While safety and efficacy with sofosbuvir remains uncertain, data are now available to support utilizing a dose adjustment when glomerular filtration rates are <30 mL/min. Upcoming regimens grazoprevir/elbasvir and daclatasvir/asunaprevir/beclavubir may provide further options for patients with advanced kidn...Continue Reading

References

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Citations

Sep 28, 2017·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Lamis R KaraouiElias B Chahine
Sep 9, 2016·World Journal of Gastroenterology : WJG·Juliana Cristina Santiago BastosClarice Weis Arns
Jul 18, 2017·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Marcello PersicoMario Masarone
Feb 11, 2020·JHEP Reports : Innovation in Hepatology·Elizabeth C VernaRobert S Brown
Jan 12, 2021·Expert Review of Anti-infective Therapy·Szu-Jen WangMing-Lung Yu

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