NDT Advance Access published online on November 27, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm724
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Pegylated Interferon Alfa-2a (40 kD) and Ribavirin in Haemodialysis Patients with Chronic Hepatitis C
1 Department of Nephrology, Rijnstate Hospital, Arnhem 2 Department of Gastroenterology, VieCurie Hospital, Venlo 3 Department of Gastroenterology, Rijnstate Hospital, Arnhem 4 Department of Internal Medicine, Catharina Hospital, Eindhoven 5 Department of Hepatology, Erasmus Medical Center, Rotterdam 6 Department 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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