학술논문
Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis
Document Type
Article
Author
Po-yao Hsu; 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
Source
Clinical and Molecular Hepatology(대한간학회지) / Clinical and Molecular Hepatology (CMH). Jan 01, 2021 27(1):186
Subject
Language
English
ISSN
2287-2728
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. (Clin Mol Hepatol 2021;27:186-196)