Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis

Clinical and Molecular Hepatology

Po-Cheng Liang¹  Ming-Yen Hsieh¹  Ming-Lung Yu¹  Ming-Lun Yeh¹  Wan-Long Chuang¹  Chung-Feng Huang¹  Yi-Hung Lin¹  Zu-Yau Lin¹  Tyng-Yuan Jang¹  Meng-Hsuan Hsieh¹  Chia-Yen Dai¹  Jee-Fu Huang¹  Shinn-Cherng Chen¹  Ching-I Huang¹  Cheng-Ting Hsu¹  Jiun-Chi Huang²  Yi-Wen Chiu²  Sheng-Wen Niu²  Shang-Jyh Hwang²  Jia-Jung Lee²  Jer-Ming Chang²  Szu-Chia Chen²  Yu-Ju Wei³  Po-Yao Hsu³ 

[1] Division of Hepatobiliary, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;

关键词: hepatitis c, chronic;    antiviral agents;    polypharmacy;    drug interactions;   

DOI  :  10.3350/cmh.2020.0180

来源: DOAJ

【 摘 要 】

Background/Aims Direct‐acting antivirals (DAAs) have been approved for hepatitis C virus (HCV) treatment in patients with end-stage renal disease (ESRD) on hemodialysis. Nevertheless, the complicated comedications and their potential drug-drug interactions (DDIs) with DAAs might limit clinical practice in this special population. Methods The number, class, and characteristics of comedications and their potential DDIs with five DAA regimens were analyzed among HCV-viremic patients from 23 hemodialysis centers in Taiwan. Results Of 2,015 hemodialysis patients screened in 2019, 169 patients seropositive for HCV RNA were enrolled (mean age, 65.6 years; median duration of hemodialysis, 5.8 years). All patients received at least one comedication (median number, 6; mean class number, 3.4). The most common comedication classes were ESRD-associated medications (94.1%), cardiovascular drugs (69.8%) and antidiabetic drugs (43.2%). ESRD-associated medications were excluded from DDI analysis. Sofosbuvir/velpatasvir/voxilaprevir had the highest frequency of potential contraindicated DDIs (red, 5.6%), followed by glecaprevir/pibrentasvir (4.0%), sofosbuvir/ledipasvir (1.3%), sofosbuvir/velpatasvir (1.3%), and elbasvir/grazoprevir (0.3%). For potentially significant DDIs (orange, requiring close monitoring or dose adjustments), sofosbuvir/velpatasvir/voxilaprevir had the highest frequency (19.9%), followed by sofosbuvir/ledipasvir (18.2%), glecaprevir/pibrentasvir (12.6%), sofosbuvir/velpatasvir (12.6%), and elbasvir/grazoprevir (7.3%). Overall, lipid-lowering agents were the most common comedication class with red-category DDIs to all DAA regimens (n=62), followed by cardiovascular agents (n=15), and central nervous system agents (n=10). Conclusions HCV-viremic patients on hemodialysis had a very high prevalence of comedications with a broad spectrum, which had varied DDIs with currently available DAA regimens. Elbasvir/grazoprevir had the fewest potential DDIs, and sofosbuvir/velpatasvir/voxilaprevir had the most potential DDIs.

【 授权许可】

Unknown