Pharmacokinetics, Efficacy, and Safety of Hepatitis C Virus Drugs in Patients with Liver and/or Renal Impairment

Elise J. Smolders, Clara T. M. M. Kanter, Bart Hoek, Joop E. Arends, Joost P. H. Drenth and David M. Burger ()
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Elise J. Smolders: Radboud university medical center
Clara T. M. M. Kanter: University Medical Center Utrecht
Bart Hoek: Leids University Medical Center
Joop E. Arends: University Medical Center Utrecht
Joost P. H. Drenth: Radboud university medical center
David M. Burger: Radboud university medical center

Drug Safety, 2016, vol. 39, issue 7, No 1, 589-611

Abstract: Abstract Hepatitis C virus (HCV)-infected patients often suffer from liver cirrhosis, which can be complicated by renal impairment. Therefore, in this review we describe the treatment possibilities in HCV patients with hepatic and renal impairment. Cirrhosis alters the structure of the liver, which affects drug-metabolizing enzymes and drug transporters. These modifications influence the plasma concentration of substrates of drugs metabolized/transported by these enzymes. The direct-acting antivirals (DAAs) are substrates of, for example, cytochrome P450 enzymes in the liver. Most DAAs are not studied in HCV-infected individuals with decompensated cirrhosis, and therefore awareness is needed when these patients are treated. Most DAAs are contraindicated in cirrhotic patients; however, patients with a Child-Pugh score of B or C can be treated safely with a normal dose sofosbuvir plus ledipasvir or daclatasvir, in combination with ribavirin. Patients with renal impairment (glomerular filtration rate [GFR]

Date: 2016
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DOI: 10.1007/s40264-016-0420-2

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