Ribavirin Combination Therapy of Chronic Hepatitis C Patients with End Stage Renal Disease: Review of Evidences on Efficacy and Safety

Background and Aims: Only few small studies have evaluated efficacy of ribavirin in combination with pegylated interferon or standard interferon in hemodialysis patients. In current review, we aim to determine the efficacy and safety of ribavirin-containing regimen in these patients.

Methods: Medline, Scopus, ISI web of knowledge and Proquest were searched for prospective studies of IFN and PEG-IFN combined with ribavirin in IFN-naive dialysis patients with chronic Hepatitis C infection. Reporting of HCV RNA results at least 6 months after treatment using a PCR assay was mandatory.

Results: From 17 relevant studies, six studies met our inclusion criteria. Because of high level of heterogeneity and low number of studies, we discarded meta-analysis. Two studies investigated standard interferon plus ribavirin. One reported 66% of Sustained Viral Response and zero treatment discontinuation. In contrast, another study reported just 16% of Sustained Viral Response and 33% of treatment discontinuation. Four studies investigated pegylated interferon plus ribavirin. One study reported amazing Sustained Viral Response rate of 97%, however, another study reported Sustained Viral Response rate of just 28.6% and treatment discontinuation rate of 71.4%. Other reported Sustained Viral Response and treatment discontinuation rates were 50%, 70% and 16%, respectively.

Conclusion: Individuals on dialysis with chronic hepatitis C who were treated with interferon or pegylated interferon plus ribavirin can have higher Sustained Viral Response rate than dialysis patients treated with interferon or pegylated interferon alone. Administration of ribavirin with close monitoring of CBC and serum ribavirin concentration can be safe.