In patients with chronic kidney disease (CKD) and hepatitis C virus (HCV) infection, direct-acting antiviral therapy with sofosbuvir is safe and effective, and may improve kidney function, according to a study recently published in the Clinical Journal of the American Society of Nephrology.
“The use of direct-acting antiviral therapy in patients with hepatitis C infection has transformed the illness into a curable one. This study shows that these medications can be safely and effectively used in patients with stage 1-3 kidney disease,” said Meghan Sise, MD, MS, Massachusetts General Hospital, Boston, MA.
Sofosbuvir is a direct-acting antiviral agent for use in patients with HCV. The potential for kidney toxicity with this agent, however, is a concern, particularly in patients with CKD. HCV infection is the most frequent chronic viral infection in the United States, and is common in patients with CKD.
To assess the safety and efficacy of sofosbuvir in these patients, Dr. Sise and fellow researchers conducted a study in 98 subjects with CKD of varying degress (stages 1-3) treated with sofosbuvir-based therapy.
Patients demonstrated an overall sustained virologic response of 81%, and stable average kidney function throughout treatment. In addition, those with more advanced CKD were more likely to be cured of HCV infection compared with those with only mild CKD, and demonstrated improvements in kidney function as well.
Finally, Dr. Sise and colleagues found that although adverse events were common (81%), sofosbuvir was reasonably well-tolerated, with only 17% of patients experiencing serious adverse events, and only 8% discontinuing treatment. Finally, they found that CKD severity had no measurable effects on the incidence of adverse events.
In an accompanying editorial, Richard Johnson, MD, University of Colorado, Denver, CO, and Michiko Shimada, MD, PhD, Hirosaki University Graduate School of Medicine, Hirosaki, Japan, commented that other antiviral drugs can also be effective in treating patients with CKD and HCV infection, but unlike sofosbuvir, are not eliminated by the kidneys. They called for additional research centered on the safety and efficacy of these different antivirals in this specific patient subset.
“We predict that HCV, like hepatitis B virus and HIV, will slowly disappear as a major medical problem for patients with renal disease,” they concluded.