Glicepravir and Pibrentasvir in patients with renal impairment


In a multicentre open-label study 104 patients with stage 4 or 5 chronic kidney disease and hepatitis C were treated with glicepravir and pibrentasvir for 12 weeks. Patients with and without compensated cirrhosis were included. 19 % had compensated cirrhosis. The most common genotype was 1, evenly divided between 1a and 1b, followed by genotype 4, 2, 3 and one each of genotype 5 and 6. No patient received ribavirin. SVR 12 was achieved by all but two patients (98 %). Another two patients were lost to follow up between week 12 and 24 post treatment. Serious adverse events were reported in 24 % of the patients. None of the serious adverse events were considered to be drug-related. Four patients discontinued therapy prematurely due to adverse events. Three of the four patients achieved SVR despite premature discontinuation. One of the two patients that did not achieve SVR12 died as a result of cerebral haemorrhage 2 weeks posttreatment and had undetectable HCV-RNA in the last available sample. The second patient who did not achieve SVR12 discontinued therapy after 4 weeks of treatment due to diarrhea. No relapses occurred.

Gane et al. N Engl J Med 2017;377:1448-1455

Comment: We now have several excellent treatment options for hepatitis C in patients with renal impairment with treatment results comparable to patients with normal kidney function.