Hemodiyaliz Hastalarında Kronik Hepatit C Virüs Enfeksiyonu: Tedavi Sonuçları ve İlaç-İlaç Etkileşimleri Yönetimi

Amaç: Bu çalışmanın amacı kronik hepatit C virüs (HCV) pozitif hemodiyaliz hastalarında paritaprevir/ritonavir/ombitasvir/dasabuvir (PROD),ledipasvir/sofosbuvir (LDV/SOF) ve peginterferon (Peg-IFN) alfa-2a tedavilerinin HCV enfeksiyonu eliminasyonundaki başarısının ve direkt etkiliantiviral (DEA) alan hastaların eş zamanlı ilaç-ilaç etkileşimleri yönetiminin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: HCV genotip 1 ile enfekte 10 hastanın demografik özellikleri, komorbid hastalıkları, laboratuvar verileri ve aldıkları tedavi rejimive süreleri hastane kayıt sisteminden retrospektif taranarak kaydedildi. Hastalar aldıkları tedavi rejimine göre 3 gruba ayrıldı: PROD, LDV/SOF vePeg-IFN. Tedavi süresince ve sonrasında virolojik yanıt, yan etkiler, biyokimyasal ve hematolojik parametreler ile ilgili veriler analiz edildi. Ayrıca DEAtedavi rejimi alan hastalarda eş zamanlı ilaç kullanımı ve etkileşimi değerlendirildi.Bulgular: Ortanca yaş 48 (aralık, 21-74) yıl, hastaların 5’i (%50) kadındı. Hastaların 2’si (%20) LED/SOF, 5’i (%50) PROD ve 3’ü (%30) Peg-IFN tedavisialdı. Hastaların 6’sı (%60) daha önce tedavi deneyimli olup Peg-IFN tedavisine yanıtsızlardı. Tüm hastalar kalıcı virolojik yanıt elde etti (%100).Bir yıllık takip süresi sonunda hastaların hiçbirinde HCV reaktivasyonu gerçekleşmedi ve böylece HCV hemodiyaliz ünitemizden elimine edildi.Hiçbir hasta tedavi süresince ilacın kesilmesine yol açan ciddi bir olumsuz olay yaşamadı. İlaç-ilaç etkileşimleri, DEA alan 7 hastanın 2’sinde tedavibaşlangıcı ile birlikte modifiye edildi.Sonuç: Hemodiyaliz hastalarındaki çoklu ilaç kullanımı ve komorbiditeler göz önüne alındığında nefrolog liderliğindeki multidisipliner yaklaşımtedaviye erişimin artması ve hastaların daha etkin yönetimini için çok önemlidir.

Chronic Hepatitis C Virus Infection in Hemodialysis Patients: Treatment Outcomes and Drug-drug Interactions Management

Objectives: The aim of this study was to evaluate the success of the paritaprevir/ritonavir/ombitasvir/dasabuvir (PROD), ledipasvir/sofosbuvir (LDV/ SOF) and peginterferon (Peg-IFN) alfa-2a in the elimination of chronic hepatitis C virus (HCV) infection in HCV positive hemodialysis patients, and to assess the management of concomitant drug-drug interactions in patients receiving direct acting antiviral (DAA). Materials and Methods: The demographical characteristics, comorbid diseases, laboratory data, and treatment regimen and duration of 10 patients who were infected with HCV genotype 1 were retrospectively screened from the electronic hospital records. The patients were divided into 3 groups according to treatment regimen: PROD, LDV/SOF and Peg-IFN. Data on virologic response, adverse events, and biochemical and hematological parameters during and after therapy were analyzed. Also, concomitant drug use and drug-drug interactions were evaluated in patients receiving DAA regimen. Results: The median age was 48 (21-74) years, 5 (50%) of patients were female. 2 patients (20%) received LDV/SOF, 5 (50%) PROD and 3 (30%) Peg- IFN. Six of patients (60%) were HCV treatment-experienced and were failed to previous Peg-IFN therapy. All patients achieved sustained virologic response (100%). At the end of the one-year follow-up period, none of patients presented with HCV reactivation, and thus HCV was eliminated from our hemodialysis unit. No patient experienced serious adverse event leading to medication discontinuation during the course of treatment. Drug-drug interactions had to be modified with the treatment initiation in 2 out of 7 patients who received DAA. Conclusion: When multidrug use and comorbidities in hemodialysis patients are considered, multidisciplinary approach led by nephrologist are very important for increased access to treatment and more effective management of patients.

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