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KMID : 1040620210270010186
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Clinical and Molecular Hepatology
2021 Volume.27 No. 1 p.186 ~ p.196
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Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis
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Hsu Po-Yao
Wei Yu-Ju
Lee Jia-Jung
Niu Sheng-Wen
Huang Jiun-Chi
Hsu Cheng-Ting
Jang Tyng-Yuan
Yeh Ming-Lun
Huang Ching-I
Liang Po-Cheng
Lin Yi-Hung
Hsieh Ming-Yen
Hsieh Meng-Hsuan
Chen Szu-Chia
Dai Chia-Yen
Lin Zu-Yau
Chen Shinn-Cherng
Huang Jee-Fu
Chang Jer-Ming
Hwang Shang-Jyh
Chuang Wan-Long
Huang Chung-Feng
Chiu Yi-Wen
Yu Ming-Lung
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Abstract
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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.
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KEYWORD
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Hepatitis C, Chronic, Antiviral agents, Polypharmacy, Drug interactions
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