Yap J E, Jaiswal P, Ton L, Szynkarek R, Attar B M, Gandhi S
Division of Gastroenterology and Hepatology, Cook County Health and Hospitals System, Chicago, IL, USA.
Department of Internal Medicine, Cook County Health and Hospitals System, Chicago, IL, USA.
J Clin Pharm Ther. 2018 Oct;43(5):730-732. doi: 10.1111/jcpt.12713. Epub 2018 Jun 15.
Elbasvir/grazoprevir is an all-oral regimen approved for patients with hepatitis C virus (HCV) genotypes 1 and 4, and in renal insufficiency. However, to date, no data exist on the efficacy of this regimen when it is crushed and administered through a percutaneous endoscopic gastrostomy (PEG) tube. Here, we illustrate the case of a 63-year-old man who is the only known patient with HCV infection in the English literature to have successfully achieved a sustained viral response (SVR) when elbasvir/grazoprevir oral combination was administered through a PEG tube.
A 63-year-old man with worsening HCV-associated membranoproliferative glomerulonephritis was referred to the gastroenterology clinic for prompt HCV treatment. He had history of high-grade mucoepidermoid carcinoma of the parotid status post-resection and was expected to develop severe mucositis and dysphagia during radiation precluding typical oral therapy of his HCV. He received a PEG tube for nutrition and underwent a 16 week course of crushed Elbasvir/Grazoprevir for HCV treatment through the PEG. At the end of the therapy he achieved SVR and his kidney function also improved.
We present the first known clinical case of a non-cirrhotic patient with HCV genotype 1A with HCV-related MPGN treated successfully with crushed Elbasvir/Grazoprevir administered through a PEG tube. With the prevalence of PEG tube insertion and HCV on a rise, we expect these 2 population cohorts to intersect in the future. Our report may serve as a guidance in such clinical scenario.
艾尔巴韦/格拉瑞韦是一种全口服方案，已被批准用于治疗丙型肝炎病毒（HCV）1型和4型感染患者以及肾功能不全患者。然而，迄今为止，尚无关于该方案碾碎后通过经皮内镜下胃造口术（PEG）管给药时疗效的数据。在此，我们介绍一例63岁男性患者，他是英文文献中已知的唯一一例HCV感染患者，在通过PEG管给予艾尔巴韦/格拉瑞韦口服复方制剂后成功实现了持续病毒学应答（SVR）。
一名患有HCV相关膜增生性肾小球肾炎且病情恶化的63岁男性被转诊至胃肠病科门诊以接受及时的HCV治疗。他曾有腮腺高级别黏液表皮样癌切除病史，预计在放疗期间会出现严重的黏膜炎和吞咽困难，从而无法进行典型的HCV口服治疗。他接受了PEG管以补充营养，并通过PEG管接受了为期16周的碾碎的艾尔巴韦/格拉瑞韦HCV治疗疗程。治疗结束时，他实现了SVR，肾功能也有所改善。
我们报告了首例已知的非肝硬化HCV 1A基因型且患有HCV相关MPGN的患者，通过PEG管给予碾碎的艾尔巴韦/格拉瑞韦成功治疗的临床病例。随着PEG管置入和HCV患病率的上升，我们预计这两个群体在未来会有交集。我们的报告可为这种临床情况提供指导。
