Fresenius Kidney Care developed a hepatitis C eradication program that resulted in a 97% cure rate among patients on dialysis who received direct-acting antiviral therapy.
Jeffrey L. Hymes
Healio Gastroenterology and Liver Disease spoke with Jeffrey L. Hymes, MD, chief medical officer of Fresenius Kidney Care, about the center’s partnership with the Scripps Clinic Liver Research Consortium to develop a protocol of screening, testing and appropriate treatment application.
“Hepatitis C has been recognized as a problem in dialysis patients for a number of years. The risk for infection from blood transfusions and frequent hospitalizations in the general population are more concentrated in the dialysis population,” Hymes told Healio Gastroenterology and Liver Disease. “The problem was that the treatments that had been available for hepatitis C were really not appropriate for patients on dialysis. Either the treatments were renally excreted or the treatments were particularly toxic and not effective enough.”
With the approval of Zepatier (elbasvir/grazoprevir, Merck) for treatment in patients with end stage renal disease, however, Hymes and colleagues saw it as an “opportunity to eradicate the disease in our population,” he said.
While treatment with elbasvir/grazoprevir is only approved for genotype 1 and 4, the center has managed to treat 500 patients with 97% achieving sustained virologic response.
“The other important thing we wanted was to recognize that hepatitis C treatment was not necessarily a comfortable area for most nephrologists, but like we’ve seen in a lot of primary care clinics, treatment is no longer solely performed by liver specialists and there was a significant portion of our patient population that could be safely treated by nephrologists,” Hymes said.
For more complicated cases, Hymes and colleagues turned to Scripps to determine identifying factors for which patients would need additional gastroenterology and hepatology specialist expertise.
Additionally, the program included a “patient advocate” group of nurse specialists whose job was to guide patients through treatment — including ordering follow-up liver function tests — and have conversations with patients about the importance of testing and treatment.
Going forward, Hymes said that the center is preparing to relaunch the program with use of Mavyret (glecaprevir/pibrentasvir, AbbVie), which can be administered to all genotypes and completed over a shorter 8-week course.
“Even though our patients have a lot of illnesses that complicate treatment, there is good evidence that being infected with hepatitis C does have an effect on longevity and quality of life. We also have good evidence that we can successfully treat and cure patients under the supervision of nephrologists,” Hymes said. “I would certainly encourage all dialysis organizations to take a hard look at their handling of hepatitis C in their patients. We have a circumstance to eradicate a disease, which something in nephrology is not always common.” – by Talitha Bennett
Disclosure: Hymes is the chief medical officer of Fresenius Kidney Care.