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A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD

INTRODUCTION: Direct-acting antivirals (DAAs) have improved treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD). To facilitate the 2022 update of the Kidney Disease: Improving Global Outcomes (KDIGO) guideline for CKD patients with HCV, we systematically revi...

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Autores principales: Balk, Ethan M., Adam, Gaelen P., Jadoul, Michel, Martin, Paul, Gordon, Craig E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9939364/
https://www.ncbi.nlm.nih.gov/pubmed/36815114
http://dx.doi.org/10.1016/j.ekir.2022.11.008
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author Balk, Ethan M.
Adam, Gaelen P.
Jadoul, Michel
Martin, Paul
Gordon, Craig E.
author_facet Balk, Ethan M.
Adam, Gaelen P.
Jadoul, Michel
Martin, Paul
Gordon, Craig E.
author_sort Balk, Ethan M.
collection PubMed
description INTRODUCTION: Direct-acting antivirals (DAAs) have improved treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD). To facilitate the 2022 update of the Kidney Disease: Improving Global Outcomes (KDIGO) guideline for CKD patients with HCV, we systematically reviewed DAA regimens in patients with CKD stages G4 and G5 nondialysis (G4–G5ND), CKD stage G5 on dialysis (G5D), and kidney transplant recipients (KTRs). METHODS: We conducted a systematic review by searching PubMed, Embase, Cochrane, CINAHL, and ClinicalTrials.gov through February 1, 2022, and conferences from 2019 to 2021. Studies of HCV-infected patients with CKD G4–G5ND, G5D, and KTRs treated with specified DAA regimens were included. Outcomes included death at 6 months or later, sustained virologic response at 12 weeks (SVR12), serious adverse events (SAEs) attributed to DAA, and treatment discontinuation because of adverse events. Maximum likelihood meta-analyses were determined; certainty of evidence was assessed per GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RESULTS: We identified 106 eligible studies (22 reported on CKD G4–G5ND, 69 on CKD G5D, and 29 on KTRs). In each population, the majority of DAA regimens achieved SVR12 ≥ 93%. We found generally low quality of evidence of low risk of SAEs (mostly 0%, up to 2.9%) and low risk of discontinuation because of adverse events (mostly 0%−5%). Across 3 unadjusted observational studies in KTRs, the risk of death after DAA treatment was substantially lower than without treatment (summary odds ratio, 0.16; 95% CI, 0.04–0.61). CONCLUSION: Combination DAA regimens are safe and highly effective in patients with advanced CKD, on dialysis, and with kidney transplants.
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spelling pubmed-99393642023-02-21 A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD Balk, Ethan M. Adam, Gaelen P. Jadoul, Michel Martin, Paul Gordon, Craig E. Kidney Int Rep Clinical Research INTRODUCTION: Direct-acting antivirals (DAAs) have improved treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD). To facilitate the 2022 update of the Kidney Disease: Improving Global Outcomes (KDIGO) guideline for CKD patients with HCV, we systematically reviewed DAA regimens in patients with CKD stages G4 and G5 nondialysis (G4–G5ND), CKD stage G5 on dialysis (G5D), and kidney transplant recipients (KTRs). METHODS: We conducted a systematic review by searching PubMed, Embase, Cochrane, CINAHL, and ClinicalTrials.gov through February 1, 2022, and conferences from 2019 to 2021. Studies of HCV-infected patients with CKD G4–G5ND, G5D, and KTRs treated with specified DAA regimens were included. Outcomes included death at 6 months or later, sustained virologic response at 12 weeks (SVR12), serious adverse events (SAEs) attributed to DAA, and treatment discontinuation because of adverse events. Maximum likelihood meta-analyses were determined; certainty of evidence was assessed per GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RESULTS: We identified 106 eligible studies (22 reported on CKD G4–G5ND, 69 on CKD G5D, and 29 on KTRs). In each population, the majority of DAA regimens achieved SVR12 ≥ 93%. We found generally low quality of evidence of low risk of SAEs (mostly 0%, up to 2.9%) and low risk of discontinuation because of adverse events (mostly 0%−5%). Across 3 unadjusted observational studies in KTRs, the risk of death after DAA treatment was substantially lower than without treatment (summary odds ratio, 0.16; 95% CI, 0.04–0.61). CONCLUSION: Combination DAA regimens are safe and highly effective in patients with advanced CKD, on dialysis, and with kidney transplants. Elsevier 2022-12-01 /pmc/articles/PMC9939364/ /pubmed/36815114 http://dx.doi.org/10.1016/j.ekir.2022.11.008 Text en © 2022 International Society of Nephrology. Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Balk, Ethan M.
Adam, Gaelen P.
Jadoul, Michel
Martin, Paul
Gordon, Craig E.
A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD
title A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD
title_full A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD
title_fullStr A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD
title_full_unstemmed A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD
title_short A Systematic Review of Direct-Acting Antivirals for Hepatitis C in Advanced CKD
title_sort systematic review of direct-acting antivirals for hepatitis c in advanced ckd
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9939364/
https://www.ncbi.nlm.nih.gov/pubmed/36815114
http://dx.doi.org/10.1016/j.ekir.2022.11.008
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