Combination glecaprevir, pibrentasvir with ezetimibe prevents HCV in transplantation
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LONDON — Combined glecaprevir and pibrentasvir with ezetimibe prevented hepatitis C infection among patients who received non-liver solid organ transplants with HCV viremic grafts, according to research.
“We have an availability of safe, well-tolerated and highly effective hepatitis C therapies with direct acting antiviral agents,” Bashar Aqel, MD, a gastroenterologist and transplant hepatologist at the Mayo Clinic in Phoenix, told attendees at the International Liver Congress. “Use of HCV viremic grafts has been associated with a reduced wait time, good graft and patient survival, and very favorable cost effectiveness. ... Glecaprevir/pibrentasvir is a highly effective, pangenotypic [direct acting antiviral agent] with confirmed safety in patients with kidney disease and minimal drug-to-drug interaction.”
In a multicenter, prospective, open-label study, Aqel and colleagues assessed the efficacy and cost effectiveness of preemptive therapy of combined glecaprevir/pibrentasvir (G/P) with ezetimibe in 38 patients (median age, 60 years; 63% men) who received non-liver HCV viremic solid organ transplantation (32 kidney, 2 kidney/pancreas, 3 heart and 1 heart/kidney).
Patients initiated therapy before start of operation and through 7 days after transplant (8 doses). Researchers monitored HCV RNA up to 24 weeks post-transplant and followed patients for 1 year to determine graft and patient survival. Aqel noted confirmed viremia among all donors.
Researchers reported transient viremia among 28 patients and detectable HCV RNA among four patients 2 weeks post-transplant, one of whom remained detectable at 3 weeks post-transplant. At 7 days post-transplant, 12 patients had detectable viremia. All patients achieved undetectable HCV RNA by 4 weeks post-transplant and remained negative at 13 weeks post-transplant.
Aqel and colleagues noted that the cost of this preemptive therapy was lower compared with standard-of-care, reactive treatment. They further reported that treatment was well-tolerated among all patients.
“In this largest, multicenter U.S. experience, preemptive hepatitis C therapy with G/P with ezetimibe for 8 days was 100% effective to prevent chronic hepatitis C infection in non-solid organ recipients of HCV viremic grafts. As expected, graft and patient survival are excellent,” Aqel concluded. “This practice has several advantages, including cost saving per patient when compared to the reactive therapy. It can eliminate the risk of hepatitis C viremia and the risks associated with that, and hopefully will enhance the use of HCV viremic grafts across other transplant centers.”
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Aqel B, et al. Abstract OS002. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
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