Letter to the Editor American
Journal of
Nephrology
Published online: June 3, 2015
Am J Nephrol 2015;41:302 DOI: 10.1159/000432408
Hemodialysis Patients with Hepatitis C Infection Are Not Receiving the New Antiviral Medications David A. Goodkin Brian Bieber Arbor Research Collaborative for Health, Ann Arbor, Mich., USA
We identified 980 HD patients with HCV infection included in the DOPPS between April 2012 and December 2014 across 21 participating nations. We searched for prescription of boceprevir, dasabuvir, ledipasvir, ombitasvir, paritaprevir, simeprevir, sofosbuvir, or telaprevir. One patient received simeprevir, in the United States, and 1 patient received telaprevir, in Australia; none of the other drugs were prescribed. Thus, only 2 patients out of 980 received any of the improved medications. Not all of the drugs were on the market for the full observation period, but in February 2015 the manufacturer of sofosbuvir and ledipasvir stated that 140,000 patients had begun therapy in the United States since the approval of sofosbuvir in December 2013 [4], demonstrating that physicians are taking advantage of new agents in the non-CKD population. HD patients with HCV infection were very rarely treated with interferonbased therapy in past years and they con-
© 2015 S. Karger AG, Basel 0250–8095/15/0415–0302$39.50/0 E-Mail [email protected] www.karger.com/ajn
tinue to go untreated even following the introduction of new, improved antiviral agents.
References 1 Goodkin DA, Bieber B, Gillespie B, Robinson BM, Jadoul M: Hepatitis C infection is very rarely treated among hemodialysis patients. Am J Nephrol 2013;38:405–412. 2 Kidney Disease; Improving Global Outcome: KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int 2008; 109:S1–S99. 3 Young EW, Goodkin DA, Mapes DL, Port FK, Keen ML, Chen K, Maroni BL, Wolfe RA, Held PJ: The dialysis outcomes and practice patterns study (DOPPS): an international hemodialysis study. Kidney Int 2000; 57(suppl 74):S74–S81. 4 Pollack A: Sales of new hepatitis C drug soar to $10.3 billion, straining budgets. The New York Times February 4, 2015, p B2.
David A. Goodkin, MD 3807 134th Avenue NE Bellevue, WA 98005 (USA) E-Mail davidagoodkin @ comcast.net
Downloaded by: University of Manitoba 198.143.32.65 - 6/23/2015 12:01:44 AM
Dear Editor In 2013, we reported that hepatitis C infection has very rarely been treated among hemodialysis (HD) patients internationally (1%), despite a prevalence of 9.5% and the fact that infection is associated with hepatic complications and increased mortality [1]. KDIGO has recommended that HCV-infected HD patients awaiting renal transplantation should be treated and that other infected patients should be assessed on a case-by-case basis [2]. The undesirable side effects of traditional therapy with parenteral interferon and sometimes ribavirin, including fatigue, depression, and severe anemia, had to be weighed against the potential benefits. However, newer, oral antiviral agents have now been shown to have far higher viral response/cure rates and they do not cause the worrisome side effects. Hence, we searched the medications database from the international Dialysis Outcomes and Practice Patterns Study (DOPPS) [3] to ascertain whether HD patients are now being prescribed the new agents.
Journal of
Nephrology
Published online: June 3, 2015
Am J Nephrol 2015;41:302 DOI: 10.1159/000432408
Hemodialysis Patients with Hepatitis C Infection Are Not Receiving the New Antiviral Medications David A. Goodkin Brian Bieber Arbor Research Collaborative for Health, Ann Arbor, Mich., USA
We identified 980 HD patients with HCV infection included in the DOPPS between April 2012 and December 2014 across 21 participating nations. We searched for prescription of boceprevir, dasabuvir, ledipasvir, ombitasvir, paritaprevir, simeprevir, sofosbuvir, or telaprevir. One patient received simeprevir, in the United States, and 1 patient received telaprevir, in Australia; none of the other drugs were prescribed. Thus, only 2 patients out of 980 received any of the improved medications. Not all of the drugs were on the market for the full observation period, but in February 2015 the manufacturer of sofosbuvir and ledipasvir stated that 140,000 patients had begun therapy in the United States since the approval of sofosbuvir in December 2013 [4], demonstrating that physicians are taking advantage of new agents in the non-CKD population. HD patients with HCV infection were very rarely treated with interferonbased therapy in past years and they con-
© 2015 S. Karger AG, Basel 0250–8095/15/0415–0302$39.50/0 E-Mail [email protected] www.karger.com/ajn
tinue to go untreated even following the introduction of new, improved antiviral agents.
References 1 Goodkin DA, Bieber B, Gillespie B, Robinson BM, Jadoul M: Hepatitis C infection is very rarely treated among hemodialysis patients. Am J Nephrol 2013;38:405–412. 2 Kidney Disease; Improving Global Outcome: KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int 2008; 109:S1–S99. 3 Young EW, Goodkin DA, Mapes DL, Port FK, Keen ML, Chen K, Maroni BL, Wolfe RA, Held PJ: The dialysis outcomes and practice patterns study (DOPPS): an international hemodialysis study. Kidney Int 2000; 57(suppl 74):S74–S81. 4 Pollack A: Sales of new hepatitis C drug soar to $10.3 billion, straining budgets. The New York Times February 4, 2015, p B2.
David A. Goodkin, MD 3807 134th Avenue NE Bellevue, WA 98005 (USA) E-Mail davidagoodkin @ comcast.net
Downloaded by: University of Manitoba 198.143.32.65 - 6/23/2015 12:01:44 AM
Dear Editor In 2013, we reported that hepatitis C infection has very rarely been treated among hemodialysis (HD) patients internationally (1%), despite a prevalence of 9.5% and the fact that infection is associated with hepatic complications and increased mortality [1]. KDIGO has recommended that HCV-infected HD patients awaiting renal transplantation should be treated and that other infected patients should be assessed on a case-by-case basis [2]. The undesirable side effects of traditional therapy with parenteral interferon and sometimes ribavirin, including fatigue, depression, and severe anemia, had to be weighed against the potential benefits. However, newer, oral antiviral agents have now been shown to have far higher viral response/cure rates and they do not cause the worrisome side effects. Hence, we searched the medications database from the international Dialysis Outcomes and Practice Patterns Study (DOPPS) [3] to ascertain whether HD patients are now being prescribed the new agents.
