Cost-effective drug found to prevent hepatitis C transmission in kidney transplantation
Click Here to Manage Email Alerts
A short course of direct-acting anti-viral prophylaxis may be effective in preventing transmission of hepatitis C virus from kidney donors to recipients, according to study results presented virtually at the American Transplant Congress.
Citing previous trials that indicated a 12-week course of direct-acting anti-viral [DAA] drugs is effective in treating hepatitis C virus [HCV] transmission from infected donors to HCV-negative recipients, Gaurav Gupta, MD, of Virginia Commonwealth University, told the audience that translating these trials into real-life practice can be challenging.
“The one problem that you may run into is the risk of insurance denial for these very expensive DAA drugs,” he said.
With the goal of reducing the cost of therapy for patients, Gupta and colleagues investigated the efficacy of a prophylactic and short-course strategy. To do this, researchers included 80 patients without hepatitis C virus who were transplanted with a hepatitis C-positive kidney between 2017 and 2019 (recipients had a mean age of 57 years; 32% were women; 55% were African American; mean donor kidney donor profile index, 56%). Researchers noted no recipients had significant chronic liver disease.
In addition to anti-thymocyte globulin, which was followed by triple immunosuppression with tacrolimus, mycophenolate and prednisone, all patients received a short course of DAA prophylaxis.
With the primary outcome being hepatitis C virus transmission to recipient, which was tested at day 7 and 14 after transplant, Gupta said the study population was further categorized into three groups. With two doses of the treatment (one the day before transplant and one the day after), researchers found 30% had hepatitis C transmission. They then changed the protocol to 4 days of prophylaxis, which lowered the transmission rate to 9.5%.
With a 7-day course, the transmission rate was 3.5%, which Gupta called a “nice decline.”
In addition, all patients who acquired the infection achieved sustained virologic response with subsequent DAA therapy. Further results showed that, after a median follow-up of 8 months, death-censored graft survival was 99% and patient survival was 98%. There were no cases of liver dysfunction or other HCV-associated complications.
Gupta concluded, “Although the ideal duration of the treatment remains to be determined, these data indicate that DAA prophylaxis will become the standard of care in the future and may result in significant cost savings for the majority of transplants.” – by Melissa J. Webb
Reference:
Gupta G, et al. Abstract #4. Presented at: American Transplant Congress; May 30 to June 1, 2020. (virtual meeting).
Disclosure: Gupta reports receiving honoraria from CareDx, Mallinckrodt, Alexion, Relypsa and Thermo Fisher.
Collapse
Gupta G, et al. Abstract #4. Presented at: American Transplant Congress; May 30 to June 1, 2020. (virtual meeting).
Read more about
Click Here to Manage Email Alerts