HCV: APASL issues DAA guidelines for severe renal impairment

  • Kanda T & al.
  • Hepatol Int
  • 11 Dec 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • The Asian Pacific Association for the Study of the Liver (APASL) has released clinical practice recommendations for HCV direct-acting antivirals (DAAs) in severe renal impairment.

Why this matters

  • A-1 recommendations match those of the European Association for the Study of the Liver (EASL), and the American Association for the Study of Liver Diseases-Infection Disease Society of America (AASLD-IDSA).

Key recommendations

  • Stage IV/V chronic kidney disease (CKD) or hemodialysis, A-1 recommendations:
    • Genotypes (GT) 1a, 1b, 4: 12 weeks of elbasvir/grazoprevir (EBR/GZR; Zepatier);
    • All GTs: 8-16 week courses of ribavirin (RBV)-free glecaprevir/pibrentasvir (GLE/PIB, Mavyret);
    • Both are contraindicated in advanced decompensated cirrhosis.
  • GT1b in stage IV/V CKD: B-2 recommendation for a 24-week course of asunaprevir/daclatasvir (ASV/DCV) ± RBV.
    • Not available in the United States.
  • Sofosbuvir (SOF, Sovaldi) and/or RBV are not recommended for patients with stage IV/V CKD. B2 recommendations:
    • All GTs: 12-week course of low-dose SOF and full-dose DCV under close monitoring;
    • GT1: 12-week course of ledipasvir/sofosbuvir (LDV/SOF, Harvoni) under close monitoring.

Drug interactions

  • Careful management of drug-drug interactions recommended for patients using cardiovascular drugs, statins, or antiepileptic medications.

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