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Liver Int. 2016 Jun;36(6):807-16. doi: 10.1111/liv.13102. Epub 2016 Mar 24.

Safety and efficacy of sofosbuvir-containing regimens in hepatitis C-infected patients with impaired renal function.

Author information

1
University of California San Francisco, San Francisco, CA, USA.
2
Saint Louis University School of Medicine, St Louis, MO, USA.
3
Massachusetts General Hospital, Boston, MA, USA.
4
Yale University School of Medicine, New Haven, CT, USA.
5
University of North Carolina, Chapel Hill, NC, USA.
6
University of Florida, Gainesville, FL, USA.

Abstract

BACKGROUND & AIMS:

Renal clearance is the major elimination pathway for sofosbuvir (SOF). We assessed the safety and efficacy of SOF-containing regimens in patients with varying baseline estimated glomerular filtration rate (eGFR).

METHODS:

HCV-TARGET database is a multicentre, longitudinal 'real-world' treatment cohort.

RESULTS:

A total of 1789 patients [genotypes 1 (72%), 2 (17%) 3 (9%), 4-6 (2%)] had baseline eGFR determination: 73 with eGFR≤45 (18 with eGFR≤30, 5 on dialysis) were compared to 1716 with eGFR>45 ml/min/1.73 m(2) . Patients with baseline eGFR≤45 vs. >45 differed in being female (55% vs. 36%), age ≥65 years (24% vs. 16%), Black race (22% vs. 12%), having cirrhosis with decompensation (73% vs. 24%) and being post-transplant (49% vs. 10%), all P < 0.05. All patients with eGFR≤45 were treated with SOF 400 mg/day (including those on haemodialysis) and had median starting ribavirin (RBV) dose of 800 mg (IQR: 400-1200). Sustained virologic response (SVR) frequencies were similar across eGFR groups, ranging from 82-83%. Patients with eGFR ≤45 more frequently experienced anaemia, worsening renal function and serious AEs (all P < 0.05), and these associations persisted when limiting analysis to RBV-free regimens. Patients with baseline eGFR≤30 and eGFR 31-45 had similar frequencies of efficacy and safety outcomes.

CONCLUSIONS:

Sustained viral clearance was achieved in 83% of patients with renal impairment (eGFR ≤45 ml/min/1.73 m(2) ) treated with SOF-containing regimens. However, these patients had higher rates of anaemia, worsening renal dysfunction and serious adverse events regardless of use of RBV. Patient with renal impairment require close monitoring and should be treated by providers extensively experienced with SOF-containing regimens.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01474811.

KEYWORDS:

decompensated cirrhosis; haemodialysis; liver transplantation; sustained virologic response

PMID:
26923436
DOI:
10.1111/liv.13102
[Indexed for MEDLINE]

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