Örmeci Necati, Sezgin Orhan, Karaali Ridvan, Aygen Bilgehan, Turan Dilara, Yaras Serkan, Erdem İlknur, Yildiz Orhan, Karakaya Fatih, Ateş Kenan, Asiller Özgün Ö
Departments of Gastroenterology.
Department of Gastroenterology, Mersin University Medical School, Mersin.
Eur J Gastroenterol Hepatol. 2019 Apr;31(4):534-539. doi: 10.1097/MEG.0000000000001334.
Both hepatitis C virus infection (HCV) and chronic kidney disease (CKD) have been comorbid illnesses with increasing morbidity and mortality. The present study was conducted to present real-life experiences about treatment of HCV and CKD with a fixed-dose combination of paritaprevir 150 mg/day, ritonavir 100 mg/day as a booster, ombitasvir 25 mg/day, and dasabuvir 250 mg twice/day, the PROD regimen.
This was a multicenter, retrospective cohort study. Seventy-five patients with both HCV and CKD were treated with a PROD-based regimen with or without ribavirin. Fifty-three of 75 patients were on maintenance hemodialysis program. Seven patients had compensated liver cirrhosis. The patients with genotype 1a or compensated liver cirrhosis were treated with the PROD regimen and ribavirin in a dose of 200 mg every other day for 12 weeks. The patients with genotype 1b were treated with PROD for 12 weeks. The patients with genotype 4 were treated with a combination of paritaprevir, ritonavir, ombitasvir, and ribavirin 200 mg every other day.
All patients except one were HCV-RNA negative (98.6%) at the end of treatment. One patient had decompensated after the fourth day of therapy. She stopped the treatment, and she was exitus after 2 months. Two patients died of reasons not related to the drugs 2 months after negativity of HCV-RNA. Sustained viral rate 12 weeks after treatment was found in 96% of the patients.
The PROD regimen was very effective and safe for treatment in patients with HCV and CKD who were in stages 4 and 5.
丙型肝炎病毒感染(HCV)和慢性肾脏病(CKD)均为发病率和死亡率不断上升的合并症。本研究旨在介绍使用固定剂量组合方案(每日150毫克帕利瑞韦、每日100毫克利托那韦作为增效剂、每日25毫克奥比他韦以及每日两次250毫克达沙布韦,即PROD方案)治疗HCV和CKD的实际经验。
这是一项多中心回顾性队列研究。75例同时患有HCV和CKD的患者接受了基于PROD方案的治疗,部分患者联合使用了利巴韦林。75例患者中有53例接受维持性血液透析治疗。7例患者为代偿期肝硬化。基因1a型或代偿期肝硬化患者接受PROD方案治疗,并联合使用利巴韦林,剂量为隔日200毫克,疗程12周。基因1b型患者接受PROD方案治疗12周。基因4型患者接受帕利瑞韦、利托那韦、奥比他韦联合治疗,并隔日使用200毫克利巴韦林。
治疗结束时,除1例患者外,所有患者HCV-RNA均呈阴性(98.6%)。1例患者在治疗第4天后出现失代偿。她停止了治疗,2个月后死亡。2例患者在HCV-RNA转阴2个月后因与药物无关的原因死亡。治疗12周后的持续病毒学应答率在96%的患者中得以实现。
PROD方案对于4期和5期HCV和CKD患者的治疗非常有效且安全。