Sato K, Yamazaki Y, Ohyama T, Kobayashi T, Horiguchi N, Kakizaki S, Kusano M, Yamada M. Combination therapy with daclatasvir and asunaprevir for dialysis patients infected with hepatitis C virus. World J Clin Cases 2016; 4(3): 88-93 [PMID: 26989674 DOI: 10.12998/wjcc.v4.i3.88]
Corresponding Author of This Article
Ken Sato, MD, PhD, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. satoken@gunma-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ken Sato, Yuichi Yamazaki, Tatsuya Ohyama, Takeshi Kobayashi, Norio Horiguchi, Satoru Kakizaki, Masanobu Yamada, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan
Ken Sato, Yuichi Yamazaki, Norio Horiguchi, Satoru Kakizaki, Department of Gastroenterology, Heisei Hidaka Clinic, Gunma 371-0001, Japan
Motoyasu Kusano, Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, Gunma 371-8511, Japan
Author contributions: Sato K drafted the article and analyzed and interpreted the data; Yamazaki Y, Ohyama T, Kobayashi T, Horiguchi N, Kakizaki S and Kusano M analyzed the data; Yamada M approved the final version to be published.
Institutional review board statement: The institutional review board in our institute does not require more than obtaining written informed consent for the publication of case reports.
Informed consent statement: We obtained written informed consent.
Conflict-of-interest statement: The authors have declared no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ken Sato, MD, PhD, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. satoken@gunma-u.ac.jp
Telephone: +81-272-208127 Fax: +81-272-208136
Received: November 6, 2015 Peer-review started: November 9, 2015 First decision: December 18, 2015 Revised: January 12, 2016 Accepted: January 29, 2016 Article in press: January 31, 2016 Published online: March 16, 2016 Processing time: 125 Days and 12.7 Hours
Abstract
The standard antiviral therapy for dialysis patients infected with hepatitis C virus (HCV) is (pegylated) interferon monotherapy, but its efficacy is insufficient. Oral direct-acting antiviral agents (DAAs) have recently been developed for chronic hepatitis C patients. However, some DAAs have contraindications for chronic renal failure (CRF). Daclatasvir and asunaprevir are metabolized largely in the liver and are not contraindicated in CRF. Combination therapy with daclatasvir and asunaprevir was used for 4 dialysis patients infected with genotype 1b HCV. One patient had viral breakthrough, and the 3 others had sustained virological response 12. One patient was admitted for heart failure and percutaneous coronary intervention due to concomitant ischemic disease. Heart failure was unlikely to be caused by the combination therapy, as it was probably due to water overload. The patient continued to receive the combination therapy after the remission of the heart failure. The combination therapy was well tolerated in the other patients.
Core tip: Oral combination therapy with the direct-acting antiviral agents daclatasvir and asunaprevir, which are both metabolized largely in the liver, is a very useful strategy for dialysis patients infected with genotype 1b hepatitis C virus. Although there were only 4 dialysis patients, the combination therapy was effective and showed a relatively favorable safety profile. One patient was admitted for heart failure with or without pneumonitis and percutaneous coronary intervention, although the causal relationship between these adverse events and the combination therapy was interpreted as negative. Our case reports warrant further studies, although careful observation during the treatment is needed.
