Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis
- Author:
Po-Yao HSU
1
;
Yu-Ju WEI
;
Jia-Jung LEE
;
Sheng-Wen NIU
;
Jiun-Chi HUANG
;
Cheng-Ting HSU
;
Tyng-Yuan JANG
;
Ming-Lun YEH
;
Ching-I HUANG
;
Po-Cheng LIANG
;
Yi-Hung LIN
;
Ming-Yen HSIEH
;
Meng-Hsuan HSIEH
;
Szu-Chia CHEN
;
Chia-Yen DAI
;
Zu-Yau LIN
;
Shinn-Cherng CHEN
;
Jee-Fu HUANG
;
Jer-Ming CHANG
;
Shang-Jyh HWANG
;
Wan-Long CHUANG
;
Chung-Feng HUANG
;
Yi-Wen CHIU
;
Ming-Lung YU
Author Information
- Publication Type:Original Article
- From:Clinical and Molecular Hepatology 2021;27(1):186-196
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
