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Ribavirin for chronic hepatitis E virus infection in transplant recipients.

Abstract

BACKGROUND

There is no established therapy for hepatitis E virus (HEV) infection. The aim of this retrospective, multicenter case series was to assess the effects of ribavirin as monotherapy for solid-organ transplant recipients with prolonged HEV viremia.

METHODS

We examined the records of 59 patients who had received a solid-organ transplant (37 kidney-transplant recipients, 10 liver-transplant recipients, 5 heart-transplant recipients, 5 kidney and pancreas-transplant recipients, and 2 lung-transplant recipients). Ribavirin therapy was initiated a median of 9 months (range, 1 to 82) after the diagnosis of HEV infection at a median dose of 600 mg per day (range, 29 to 1200), which was equivalent to 8.1 mg per kilogram of body weight per day (range, 0.6 to 16.3). Patients received ribavirin for a median of 3 months (range, 1 to 18); 66% of the patients received ribavirin for 3 months or less.

RESULTS

All the patients had HEV viremia when ribavirin was initiated (all 54 in whom genotyping was performed had HEV genotype 3). At the end of therapy, HEV clearance was observed in 95% of the patients. A recurrence of HEV replication occurred in 10 patients after ribavirin was stopped. A sustained virologic response, defined as an undetectable serum HEV RNA level at least 6 months after cessation of ribavirin therapy, occurred in 46 of the 59 patients (78%). A sustained virologic response was also observed in 4 patients who had a recurrence and were re-treated for a longer period. A higher lymphocyte count when ribavirin therapy was initiated was associated with a greater likelihood of a sustained virologic response. Anemia was the main identified side effect and required a reduction in ribavirin dose in 29% of the patients, the use of erythropoietin in 54%, and blood transfusions in 12%.

CONCLUSIONS

This retrospective, multicenter study showed that ribavirin as monotherapy may be effective in the treatment of chronic HEV infection; a 3-month course seemed to be an appropriate duration of therapy for most patients.

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    Source

    The New England journal of medicine 370:12 2014 Mar 20 pg 1111-20

    MeSH

    Adult
    Aged
    Antiviral Agents
    Chronic Disease
    Drug Administration Schedule
    Female
    Hepatitis E
    Hepatitis E virus
    Humans
    Male
    Middle Aged
    Organ Transplantation
    Retrospective Studies
    Ribavirin
    Viral Load
    Virus Replication

    Pub Type(s)

    Journal Article
    Multicenter Study

    Language

    eng

    PubMed ID

    24645943

    Citation

    Kamar, Nassim, et al. "Ribavirin for Chronic Hepatitis E Virus Infection in Transplant Recipients." The New England Journal of Medicine, vol. 370, no. 12, 2014, pp. 1111-20.
    Kamar N, Izopet J, Tripon S, et al. Ribavirin for chronic hepatitis E virus infection in transplant recipients. N Engl J Med. 2014;370(12):1111-20.
    Kamar, N., Izopet, J., Tripon, S., Bismuth, M., Hillaire, S., Dumortier, J., ... Mallet, V. (2014). Ribavirin for chronic hepatitis E virus infection in transplant recipients. The New England Journal of Medicine, 370(12), pp. 1111-20. doi:10.1056/NEJMoa1215246.
    Kamar N, et al. Ribavirin for Chronic Hepatitis E Virus Infection in Transplant Recipients. N Engl J Med. 2014 Mar 20;370(12):1111-20. PubMed PMID: 24645943.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Ribavirin for chronic hepatitis E virus infection in transplant recipients. AU - Kamar,Nassim, AU - Izopet,Jacques, AU - Tripon,Simona, AU - Bismuth,Michael, AU - Hillaire,Sophie, AU - Dumortier,Jérôme, AU - Radenne,Sylvie, AU - Coilly,Audrey, AU - Garrigue,Valérie, AU - D'Alteroche,Louis, AU - Buchler,Matthias, AU - Couzi,Lionel, AU - Lebray,Pascal, AU - Dharancy,Sebastien, AU - Minello,Anne, AU - Hourmant,Maryvonne, AU - Roque-Afonso,Anne-Marie, AU - Abravanel,Florence, AU - Pol,Stanislas, AU - Rostaing,Lionel, AU - Mallet,Vincent, PY - 2014/3/21/entrez PY - 2014/3/22/pubmed PY - 2014/4/23/medline SP - 1111 EP - 20 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 370 IS - 12 N2 - BACKGROUND: There is no established therapy for hepatitis E virus (HEV) infection. The aim of this retrospective, multicenter case series was to assess the effects of ribavirin as monotherapy for solid-organ transplant recipients with prolonged HEV viremia. METHODS: We examined the records of 59 patients who had received a solid-organ transplant (37 kidney-transplant recipients, 10 liver-transplant recipients, 5 heart-transplant recipients, 5 kidney and pancreas-transplant recipients, and 2 lung-transplant recipients). Ribavirin therapy was initiated a median of 9 months (range, 1 to 82) after the diagnosis of HEV infection at a median dose of 600 mg per day (range, 29 to 1200), which was equivalent to 8.1 mg per kilogram of body weight per day (range, 0.6 to 16.3). Patients received ribavirin for a median of 3 months (range, 1 to 18); 66% of the patients received ribavirin for 3 months or less. RESULTS: All the patients had HEV viremia when ribavirin was initiated (all 54 in whom genotyping was performed had HEV genotype 3). At the end of therapy, HEV clearance was observed in 95% of the patients. A recurrence of HEV replication occurred in 10 patients after ribavirin was stopped. A sustained virologic response, defined as an undetectable serum HEV RNA level at least 6 months after cessation of ribavirin therapy, occurred in 46 of the 59 patients (78%). A sustained virologic response was also observed in 4 patients who had a recurrence and were re-treated for a longer period. A higher lymphocyte count when ribavirin therapy was initiated was associated with a greater likelihood of a sustained virologic response. Anemia was the main identified side effect and required a reduction in ribavirin dose in 29% of the patients, the use of erythropoietin in 54%, and blood transfusions in 12%. CONCLUSIONS: This retrospective, multicenter study showed that ribavirin as monotherapy may be effective in the treatment of chronic HEV infection; a 3-month course seemed to be an appropriate duration of therapy for most patients. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/24645943/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa1215246?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -