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