Pegylated interferon alfa-2a (40 kD) and ribavirin in haemodialysis patients with chronic hepatitis C
| Autor: | Solko W. Schalm, Rob P. R. Adang, A.C.I.T.L. Tan, Trijntje T. Cnossen, Robert van Leusen, Constantijn J. A. M. Konings, Richard A. de Vries |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Male medicine.medical_specialty Hepatitis C virus Alpha interferon Pilot Projects Interferon alpha-2 medicine.disease_cause Gastroenterology Antiviral Agents End stage renal disease Polyethylene Glycols chemistry.chemical_compound Pegylated interferon Renal Dialysis Internal medicine Ribavirin medicine Humans Interferon alfa Transplantation business.industry Interferon-alpha Hepatitis C Chronic Middle Aged Recombinant Proteins chemistry Nephrology Immunology Trough level Female business medicine.drug Peginterferon alfa-2a |
| Zdroj: | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 23(2) |
| ISSN: | 1460-2385 |
| Popis: | textabstractBackground. 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. |
| Databáze: | OpenAIRE |
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