Successful treatment of chronic hepatitis C infection with crushed elbasvir/grazoprevir administered via a percutaneous endoscopic gastrostomy tube

John Erikson Lim Yap, P. Jaiswal, L. Ton, R. Szynkarek, B. M. Attar, S. Gandhi

Research output: Contribution to journalArticle

Abstract

What is known and objective: Elbasvir/grazoprevir is an all-oral regimen approved for patients with hepatitis C virus (HCV) genotypes 1 and 4, and in renal insufficiency. However, to date, no data exist on the efficacy of this regimen when it is crushed and administered through a percutaneous endoscopic gastrostomy (PEG) tube. Here, we illustrate the case of a 63-year-old man who is the only known patient with HCV infection in the English literature to have successfully achieved a sustained viral response (SVR) when elbasvir/grazoprevir oral combination was administered through a PEG tube. Case summary: A 63-year-old man with worsening HCV-associated membranoproliferative glomerulonephritis was referred to the gastroenterology clinic for prompt HCV treatment. He had history of high-grade mucoepidermoid carcinoma of the parotid status post-resection and was expected to develop severe mucositis and dysphagia during radiation precluding typical oral therapy of his HCV. He received a PEG tube for nutrition and underwent a 16 week course of crushed Elbasvir/Grazoprevir for HCV treatment through the PEG. At the end of the therapy he achieved SVR and his kidney function also improved. What is new and conclusion: We present the first known clinical case of a non-cirrhotic patient with HCV genotype 1A with HCV-related MPGN treated successfully with crushed Elbasvir/Grazoprevir administered through a PEG tube. With the prevalence of PEG tube insertion and HCV on a rise, we expect these 2 population cohorts to intersect in the future. Our report may serve as a guidance in such clinical scenario.

Original languageEnglish (US)
Pages (from-to)730-732
Number of pages3
JournalJournal of Clinical Pharmacy and Therapeutics
Volume43
Issue number5
DOIs
StatePublished - Oct 1 2018
Externally publishedYes

Fingerprint

Gastrostomy
Chronic Hepatitis C
Hepacivirus
Infection
Membranoproliferative Glomerulonephritis
Therapeutics
Genotype
Mucoepidermoid Carcinoma
Literature
2-(pyrrolidin-2-yl)-5-(2-(4-(5-(pyrrolidin-2-yl)-1H-imidazol-2-yl)phenyl)benzofuran-5-yl)-1H-imidazole
MK-5172
Mucositis
Gastroenterology
Virus Diseases
Deglutition Disorders
Renal Insufficiency
Radiation
Kidney

Keywords

  • Hepatitis C infection
  • Zepatier
  • crushing
  • elbasvir/grazoprevir
  • percutaneous endoscopic gastrostomy tube

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Successful treatment of chronic hepatitis C infection with crushed elbasvir/grazoprevir administered via a percutaneous endoscopic gastrostomy tube. / Yap, John Erikson Lim; Jaiswal, P.; Ton, L.; Szynkarek, R.; Attar, B. M.; Gandhi, S.

In: Journal of Clinical Pharmacy and Therapeutics, Vol. 43, No. 5, 01.10.2018, p. 730-732.

Research output: Contribution to journalArticle

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abstract = "What is known and objective: Elbasvir/grazoprevir is an all-oral regimen approved for patients with hepatitis C virus (HCV) genotypes 1 and 4, and in renal insufficiency. However, to date, no data exist on the efficacy of this regimen when it is crushed and administered through a percutaneous endoscopic gastrostomy (PEG) tube. Here, we illustrate the case of a 63-year-old man who is the only known patient with HCV infection in the English literature to have successfully achieved a sustained viral response (SVR) when elbasvir/grazoprevir oral combination was administered through a PEG tube. Case summary: A 63-year-old man with worsening HCV-associated membranoproliferative glomerulonephritis was referred to the gastroenterology clinic for prompt HCV treatment. He had history of high-grade mucoepidermoid carcinoma of the parotid status post-resection and was expected to develop severe mucositis and dysphagia during radiation precluding typical oral therapy of his HCV. He received a PEG tube for nutrition and underwent a 16 week course of crushed Elbasvir/Grazoprevir for HCV treatment through the PEG. At the end of the therapy he achieved SVR and his kidney function also improved. What is new and conclusion: We present the first known clinical case of a non-cirrhotic patient with HCV genotype 1A with HCV-related MPGN treated successfully with crushed Elbasvir/Grazoprevir administered through a PEG tube. With the prevalence of PEG tube insertion and HCV on a rise, we expect these 2 population cohorts to intersect in the future. Our report may serve as a guidance in such clinical scenario.",
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