Efficacy and safety of sofosbuvir-based regimens in chronic hepatitis C patients on dialysis

Introduction

Patients with end-stage renal disease (ESRD) have poor treatment tolerance and outcome to interferon-based regimens. Sofosbuvir-based regimens have improved treatment success in chronic hepatitis C. There is limited data in ESRD patients as sofosbuvir is excreted by the kidney. Several small studies have shown good results.

Methods

Sixteen consecutive patients of ESRD (on dialysis) and chronic hepatitis C were treated with sofosbuvir-based regimens as they were prospective kidney transplantation recipients, at a tertiary care center in north India. Sofosbuvir was given 400 mg on alternate days. Data is shown as number, mean (SD), and median (range).

Results

Sixteen patients (12 males) aged 45±12 years received sofosbuvir-based treatment. These patients were on hemodialysis from 10 (2–48) months. Eleven of these patients had genotype 1, four had genotype 3, and one had genotype 4 infection; baseline RNA was 7 (5–8) log. The following treatment regimens were used: sofosbuvir, ribavirin, and low dose peginterferon (n = 8; 6 genotype 1 and one each had genotype 3 and 4); sofosbuvir and daclatasvir (n = 7); sofosbuvir, ribavirin, and daclatasvir (n = 1). Ten patients achieved end of treatment response and 8 (80%) of these achieved sustained virological response at 12 weeks (SVR12); six are on treatment. Two patients with genotype one (including one with cirrhosis) had relapse. Seven patients needed blood transfusion; interferon was stopped in one due to thrombocytopenia. Fatigue was present in 4 patients.

Conclusion

Sofosbuvir-based regimens can be used in ESRD patients on dialysis with good efficacy.