BOSTON, MA—Data from a retrospective cohort study presented at The Liver Meeting® 2016 has shown that hepatitis C virus (HCV)-infected patients with advanced chronic kidney disease (CKD) “remain a challenging population to treat,” with <10% receiving treatment in the early direct-acting antivirals (DAA) era. 

This patient population often faces challenges to treatment including higher drug exposures, a high prevalence of anemia that deters ribavirin use, and poor response rates to interferon (IFN) monotherapy. Overall, there has been limited data on HCV treatment patterns with DAA therapies in HCV patients with advanced CKD. 

AW Singer and colleagues from Gilead Sciences, Inc., aimed to examine U.S. administrative claims to study treatment uptake among patients with chronic HCV and advanced CKD in the DAA era. They identified patients with chronic HCV enrolled between January 2010 and March 2015. “Advanced CKD was defined as having any claim for ICD-9-CM codes for advanced CKD,” noted Singer. These patients were defined as “treated” if they received any HCV agents for any duration of time and had a claim for advanced CKD prior to or within 6 months of HCV treatment initiation; they were defined as “untreated” if they did not receive any HCV treatment during the observation period. 

Chi-square tests were used to analyze the differences between the HCV treated and untreated populations at baseline. A total of 179,804 adults with chronic HCV were identified, of which 15.2% received any anti-HCV treatment during the observation period. Of the total HCV patients, 3.3% were diagnosed with advanced CKD and most were aged between 45 and 64 years (75.7%), were male (69.5%), and 41.6% had a claim for dialysis at baseline. About 7% of advanced CKD patients received HCV treatment while having advanced CKD. 

“Compared to HCV untreated CKD patients, advanced CKD patients treated for HCV were more likely to be under 65 years of age, male, and have a diagnosis of cirrhosis; were less likely to have a diagnosis of anemia, type 2 diabetes, or hepatitis B virus (HBV) co-infection, and were less likely to have received dialysis at baseline,” reported Singer. 

The most common regimens among HCV-treated advanced CKD patients were: ribavirin + interferon (50% in 2012 and 39.0% in 2013), and telaprevir + ribavirin + interferon (25% in 2012 and 17.1% in 2013). 

In 2014, 92.4% of HCV-treated advanced CKD patients received sofosbuvir-containing regimens which included: sofosbuvir + simeprevir (35.3%), sofosbuvir + ribavirin (22.9%), and ledipasvir/sofosbuvir (18.2%). The majority of treated patients appeared to receive sofosbuvir-based regimens in 2014 as HCV treatment uptake grew in advanced CKD patients, the study concluded.