Determining the therapeutic range for ribavirin in transplant recipients with chronic hepatitis E virus infection

The aim of this study was to define the therapeutic range for ribavirin (RBV) in transplant recipients with chronic hepatitis E virus (HEV) infection. In this retrospective multicentre cohort study, data of adult transplant recipients with chronic HEV infection, who had been treated with RBV monotherapy between 01‐3‐2008 and 01‐08‐2018, were included. ROC curve analyses were performed, and the half‐maximal effective RBV concentration was calculated to determine a representative therapeutic range. In 96 patients, RBV monotherapy for a median of three months resulted in a sustained virologic response in 63.5% of the patients, while 88.5% of the patients developed anaemia. RBV plasma concentrations at steady state were significantly higher in clinical responders compared with clinical non‐responders: median 1.96 (IQR 1.81‐2.70) versus 0.49 (IQR 0.45‐0.73) mg/L, P = .0004. RBV caused a dose‐dependent haemoglobin reduction with higher RBV plasma concentrations resulting in more haemoglobin reduction. The therapeutic range for RBV for chronic HEV infection in transplant recipients ranges between 1.8 and 2.3 mg/L.