Treatment of Hepatitis C in Dialysis Patients with Triple Therapy: 535

Purpose: Treatment of patients with chronic hepatitis C on dialysis is not well-tolerated, and has a varied rate of sustained virologic response. Due to profound hemolytic anemia from ribavirin, standard of care is with standard interferon (INF) three times a week. Few studies have assessed the efficacy of INF or pegylated-interferon (PEG-INF) with ribavirin in this patient population. Since the introduction of the protease inhibitors, telaprevir, and boceprevir, there has been no data on tolerability or sustained virologic response (SVR). This study reports on five patients with CHC genotype 1, treated with PEG-INF, ribavirin, and telaprevir. Methods: Patients stable on hemodialysis for more than 1 year with CHC were included. All patients underwet liver biopsy prior to initiating treatment. Choice of protease inhibitor, starting dose of PEG-INF, and ribavirin were left to the discretion of the treating hepatologist. Results: Four out of five patients were male, with a mean age of 50 (31-63). Reason for dialysis was diabetes in three, recurrent UTI in one, and membranoproliferative glomerulonephritis likely due to hepatitis C in one. One patient was status post-liver transplant for CHC 11 years prior to starting therapy for HCV. Three patients had advanced fibrosis (stage 3 or higher). Mean viral load was 889,000IU/mL. All patients were treated with telaprevir 750 mg TID and started on ribavirin 200 mg a week. Initial dose of PEG-INF was 135 mcg/wk in four patients, and 180 mcg/week in one. Ribavirin was increased to 200 mg three times a week in three patients, 200 mg five times a week in one patient, and 200 mg daily in one patient. PEG-INF was able to be increased in three of the five patients to 180 mcg/wk; four patients were on this dose. Three out of five had a RVR, and three out of four had an EVR. No patient met stopping rules for therapy, and of those four patients treated through 24 weeks, all had an undetectable viral load. Two out of two had an end-of-treatment response at 48 weeks. Every patient received epoetin-alpha during dialysis, but ribavirin was never held or discontinued. All had fatigue, and one had puritis. Conclusion: Telaprevir, PEG-INF, and ribavirin is well-tolerated in patients on dialysis, with good treatment response.