A Pilot Study to Treat Patients With Chronic Hepatitis C Virus (HCV) Genotype 1 and End-Stage Renal Disease (ESRD)
A Pilot Study to Treat Patients With Chronic HCV Genotype 1 and ESRD Receiving Hemodialysis and Naïve to Prior HCV Therapy With Peginterferon Alfa-2b, the Maximally Tolerated Ribavirin Dose and Boceprevir
Lead SponsorLiver Institute of Virginia
Indication/ConditionChronic Hepatitis C End Stage Renal Disease
Intervention/Treatmentribavirin boceprevir interferon alpha-2b ...
A maximally tolerated dose of ribavirin can be defined in each patient with ESRD undergoing hemodialysis.
Patients with Chronic Hepatitis C Virus (HCV)and End-Stage Renal Disease (ESRD)undergoing hemodialysis will be able to tolerate and remain on treatment with peginterferon alfa-2b, the maximally tolerated dose of ribavirin and boceprevir.
A significant percentage of patients with chronic HCV and ESRD undergoing hemodialysis can achieve rapid virologic response (RVR), extended virologic response (eRVR) and sustained virologic response (SVR) when treated with peginterferon alfa-2b, the maximally tolerated dose of ribavirin and boceprevir.
Patients with ESRD will be treated with a dose escalation of ribavirin starting from 200 mg everyday (QD) to a maximal tolerated dose. Peginterferon will then be added. Ribavirin will be dose adjusted as needed. Boceprevir will then be added. Ribavirin will be dose adjusted as needed. Patients will be monitored for eRVR and SVR. The study end-point is eRVR.
Ribavirin monotherapy will be started at a dose of 100 mg daily. After each successive week the dose of ribavirin will be increased by 100 mg increments daily as long as the hemoglobin remains greater than 10 gm/dl and/or there has not been a decline in the hemoglobin by more than 2 gms/dl from the pretreatment baseline.
After the patient has remained on their maximal tolerated dose of ribavirin for 1 week peginterferon alpha-2b will be initiated at a dose of 1.0 mcg/kg/week. This dose was chosen because it is known to be equivalent in achieving SVR when compared to the 1.5 mcg/kg/dose and is associated with less bone marrow suppression. The dose of ribavirin will be adjusted as needed.
Boceprevir will be added after the patient is on stable doses of ribavirin and peginterferon. The dose of ribavirin will be adjusted as needed.
The efficacy and safety of HCV treatment in patients with ESRD will be assessed with a maximal tolerated dose of ribavirin, peginterferon and boceprevir.
Inclusion Criteria: Chronic HCV defined by: A history of a positive anti-HCV or HCV RNA for > 6 months or A liver biopsy demonstrating at least portal fibrosis HCV genotype 1 No prior treatment with any interferon or peginterferon preparation ESRD undergoing hemodialysis for at least 6 months Willingness not to conceive a child during treatment and for 6 months following discontinuation of treatment. Exclusion Criteria: Histologic evidence of cirrhosis Any co-existent liver disease A platelet count < 90,000 A total white blood cell (WBC) < 2.5 An absolute neutrophil count < 1.5 Hemoglobin < 11 gm/dl on Epoetin-alpha Positive test for anti-HIV Pregnancy of the patient or their intimate partner Women who are breast feeding Significant cardiovascular disease History of suicide intent, severe depression requiring hospitalization or significant psychiatric disease Malignancy within 5 years of enrollment except for squamous or basal cell skin cancer Co-existent immune disorder such as lupus, rheumatoid as arthritis, colitis, Crohns disease, sarcoidosis, etc. Any patient in the opinion of the investigator who would not be a satisfactory study candidate