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Ribavirin effectively treated transplant patients with HEV
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Ribavirin monotherapy may be an effective way to treat organ transplant patients with chronic hepatitis E virus infection, according to a recent study.
Researchers studied 59 patients who had received solid organ transplants, including 37 kidneys, 10 livers, five hearts, five kidneys and pancreas, and two lungs. All recipients tested positive for hepatitis E virus (HEV) and previously were treated with ribavirin between Sept. 10, 2009 and June 27, 2012, were treated with ribavirin monotherapy. Therapy was initiated at a median dose of 600 mg daily for 1 month. By month 2 and at the end of the 3-month therapy, median dosage decreased to 400 mg daily.
Ribavirin doses were adjusted according to patients’ glomerular filtration rates and ranged from 200 mg weekly to 1,200 mg daily; 34 patients received either 600 mg or 800 mg daily.
At 1 month, HEV RNA levels were undetectable in 64% of the assessed cohort and by the end of therapy, 98% of followed patients had HEV clearance. Among 56 patients, a recurrence of HEV replication occurred in 10. Seventy-eight percent of patients attained sustained virologic response — considered undetectable HEV RNA at least 6 months after therapy cessation. Researchers said 46 patients remained viremia-free at the most recent follow-up (median 25 months after therapy)
Adverse side effects included anemia, which required reduced ribavirin dosing in 29% of patients; 54% of patients required erythropoietin and12% needed blood transfusions No acute rejections were observed during ribavirin therapy.
“This retrospective, multicenter case series showed that ribavirin as monotherapy may be effective in treating chronic HEV infection,” the researchers wrote. “A 3-month course seems to be an appropriate duration … though a longer therapy can be given to heavily immunosuppressed patients and those who still have viremia 1 month after … initiation.”
Disclosure: See the study for a full list of relevant financial disclosures.