NDT Advance Access originally published online on November 27, 2007
Nephrology Dialysis Transplantation 2008 23(2):721-725; doi:10.1093/ndt/gfm724
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Pegylated interferon alfa-2a (40 kD) and ribavirin in haemodialysis patients with chronic hepatitis C
1Department of Nephrology, Rijnstate Hospital, Arnhem, 2Department of Gastroenterology, VieCurie Hospital, Venlo, 3Department of Gastroenterology, Rijnstate Hospital, Arnhem, 4Department of Internal Medicine, Catharina Hospital, Eindhoven, 5Department of Hepatology, Erasmus Medical Center, Rotterdam and 6Department of Gastroenterology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
Correspondence and offprint requests to: Robert van Leusen, Department of Nephrology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, the Netherlands. E-mail: vl.wittepoort{at}planet.nl
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Abstract |
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Background. Chronic hepatitis C virus (HCV) infection is associated with liver dysfunction and hepatocellular carcinoma. In patients with normal kidney function, treatment with pegylated interferon (PEG-IFN) and ribavirin (RBV) frequently leads to eradication of HCV. Treatment in dialysis patients has long been controversial and until recently, the use of RBV was considered to be contra-indicated. We used plasma trough levels of RBV to promote tolerance, safety and efficacy. PEG-IFN alfa-2a (40 kD) was chosen because it is cleared predominantly via hepatic metabolism.
Methods. Seven haemodialysis patients with chronic HCV infection were eligible and started with 135 µg PEG-IFN alfa-2a (40 kD) weekly and 200 mg RBV every other day. Dose adaptations were allowed following study guidelines. Genotypes 1 and 4 (five patients) were treated for 48 weeks and genotypes 2 and 3 (two patients) for 24 weeks. HCV-RNA was determined after 12, 24 and 48 weeks (and at 72 weeks for genotypes 1 and 4). RBV trough plasma levels were monitored regularly by HPLC-technique.
Results. All patients completed the treatment. In two patients, the PEG-IFN dose had to be reduced to 90 µg/week because of adverse events. To achieve the target range (1.5–2.5 µg/ml) of the plasma trough level, the mean RBV dose was increased to a dose between 133 and 200 mg each day in five patients. Despite an increase of the weekly erythropoietin (Epo) dose, two to a max of four red cell transfusions were given to four patients. A sustained viral response (SVR) was reached in five patients (3/5 with genotype 1/4 and 2/2 with genotype 2/3).
Conclusion. In our series of seven patients, we were able to use RBV monitoring drug levels in combination with PEG-IFN alfa-2a (40 kD) and achieve high sustained response rates. However, Epo and transfusion requirements may increase. In two patients adverse events were observed, but manageable with dose reduction of PEG-IFN.
Keywords: end-stage renal disease; HCV infection; pegylated interferon; ribavirin; sustained viral response
Received for publication: 8. 1.07
Accepted in revised form: 18. 9.07
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