Efficacy and safety of glecaprevir/pibrentasvir in renally impaired patients with chronic HCV infection

摘要

Abstract Background and Aims Chronic hepatitis C virus (HCV) infection increases the risk of incident chronic kidney disease (CKD) and progression to end‐stage renal disease (ESRD). Previously available direct‐acting antiviral regimens are not approved for patients with advanced CKD across all HCV genotypes. Methods EXPEDITION‐5 is a phase 3 study to evaluate efficacy and safety of the fixed‐dose combination of glecaprevir and pibrentasvir (G/P) for chronic HCV infection (genotype 1 through 6) in adults without cirrhosis or with compensated cirrhosis and with stage 3b, 4 or 5 CKD. Patients received approved duration of G/P according to HCV genotype, cirrhosis status and prior HCV treatment experience. The primary efficacy endpoint was percentage of patients with sustained virologic response at 12?weeks post‐treatment (SVR12). Results Among the 101 patients enrolled in the study, 24 had predialysis CKD and 76 were on dialysis. Eighty‐four patients were treated with G/P for 8?weeks, 13 patients for 12?weeks and four patients for 16?weeks. Fifty‐five per cent of patients had genotype 1, 27 had genotype 2, 15 had genotype 3 and 4 had genotype 4, and none had genotype 5 or 6 infection. The SVR12 rate was 97 (98/101, 95 confidence interval, 91.6‐99.0). No patients experienced virologic failure. Adverse events (AEs) reported in at least 5 of the patients were pruritus, bronchitis, hypertension and generalized pruritus. Serious AEs were reported in 12 of patients; none related to study drug. Conclusions G/P treatment yielded high SVR12 rates irrespective of the presence of stage 3b, 4 or 5 CKD. No safety signals were detected. Clinicaltrials.gov identifier This Phase 3 clinical trial was funded by AbbVie and registered with clinicaltrials.gov as NCT03069365 (EXPEDITION‐5).