DDSEP® 8 Quick Quiz

Question 2

A 47-year-old man with stage 5 chronic kidney disease on hemodialysis is referred to your clinic. He has genotype 1a HCV and F2 fibrosis. He wants to discuss treatment options.

What is the best advice?

He is not eligible for HCV therapy due to hemodialysis

Sofosbuvir/ledipasvir combination therapy dosed after dialysis for 12 weeks

Sofosbuvir/ledipasvir combination therapy for 12 weeks

Elbasvir/grazoprevir combination therapy for 12 weeks

Daily fixed-dose combination sofosbuvir/velpatasvir for 12 weeks

Q2. Correct Answer: D

Rationale

Elbasvir and grazoprevir are hepaticaly metabo¬lized and undergo minimal renal elimination making them safe for use in patients with end stage renal disease. The C-Surfer trial evaluated elbasvir and grazoprevir in genotype 1 patients with advanced renal disease inclusive of patients on hemodialysis. Cure rates in this trial were 94- 99 percent. Sofosbuvir containing regimen are not approved for patient with CKD stage 4-5 or those on hemodialysis, even when given in a dose reduced or post-dialysis fashion.

References

https://www.hcvguidelines.org/unique-popula¬tions/renal-impairment

Roth D, Nelson DR, Bruchfeld A, et al. Grazoprevir plus elbasvir in treatment-naive and treat¬ment experienced patients with hepatitis C virus genotype 1 infection and stage 4-5 chronic kidney disease (the C-SURFER study): a combination phase 3 study. Lancet. 2015;386(10003):1537-45.

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