The median fibrosis-4 (FIB-4) score was 1.81 (IQR, 1.34C2.85), and a high proportion of patients had FIB-4 scores lower than 3.25 (n=134, 79.2%). their potential DDIs with five DAA regimens were analyzed among HCV-viremic patients from 23 hemodialysis centers in Taiwan. Results Of 2,015 hemodialysis patients screened in 2019, 169 patients seropositive for HCV RNA were enrolled (mean age, 65.6 years; median duration of hemodialysis, 5.8 years). All patients received at least one comedication (median number, 6; mean class number, 3.4). The most common comedication classes were ESRD-associated medications (94.1%), cardiovascular drugs (69.8%) and antidiabetic drugs (43.2%). ESRD-associated medications were excluded from DDI analysis. Sofosbuvir/velpatasvir/voxilaprevir had the highest frequency of potential contraindicated DDIs (red, 5.6%), followed by glecaprevir/pibrentasvir (4.0%), sofosbuvir/ledipasvir (1.3%), sofosbuvir/velpatasvir (1.3%), and elbasvir/grazoprevir (0.3%). For potentially significant DDIs (orange, requiring close monitoring or dose adjustments), sofosbuvir/velpatasvir/voxilaprevir had the highest frequency (19.9%), followed by sofosbuvir/ledipasvir (18.2%), glecaprevir/pibrentasvir (12.6%), sofosbuvir/velpatasvir (12.6%), and elbasvir/grazoprevir (7.3%). Overall, lipid-lowering agents were the most common comedication class with red-category DDIs to all DAA regimens (n=62), followed by cardiovascular agents (n=15), and central nervous system agents (n=10). Conclusions HCV-viremic patients on hemodialysis had a very high prevalence of comedications with a broad spectrum, which had varied DDIs with currently available DAA regimens. Elbasvir/grazoprevir had the fewest potential DDIs, and sofosbuvir/velpatasvir/voxilaprevir had the most potential DDIs. strong class=”kwd-title” Keywords: Hepatitis C, Chronic; Antiviral agents; Polypharmacy; Drug interactions Graphical Abstract ? Open in a separate window INTRODUCTION Chronic hepatitis C virus (HCV) infection is one of the leading causes of liver cirrhosis, hepatocellular carcinoma (HCC) and liver-related death. The global prevalence of chronic HCV infections in 2015 was estimated to be 1.0%, corresponding to 71.1 million people [1]. HCV infection is endemic in Taiwan, with estimated prevalence rates of antibodies to HCV (anti-HCV) ranging from 3.3% to 8.6% [2-4], and leads to substantial clinical and economic burden. Taiwan has the highest prevalence and annual incidence of end-stage renal disease (ESRD) worldwide [5]. Uremic patients on maintenance hemodialysis are at great risk for HCV infection. From 2012 to 2015, the prevalence GLPG0974 of HCV infection among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study was nearly 10%, which is much higher than that in the general population [6]. Previous reports indicated that ESRD patients on dialysis with HCV infections have an increased risk of death, hospitalization, anemic complications, and worse quality of life scores than those without HCV infection [7,8]. Given the higher hepatic and extrahepatic adverse outcomes of chronic HCV infection and the benefits associated FGD4 with HCV viral clearance [9-12], effective treatment and elimination of HCV infection are essential for this specific population. Direct\acting antivirals (DAAs) have become the first\line treatment for HCV infection [13-16]. Compared to interferon-based treatment [17,18], DAA therapy is generally more tolerable, requires a GLPG0974 shorter duration, and is GLPG0974 more effective. However, the guidelines also highlight the importance of considering and monitoring potential drug\drug interactions (DDIs) between DAAs and comedications [13-16]. To avoid potential DDIs and to optimize patient safety and treatment efficacy, it is important to review all the medications taken by the patient, including over-the-counter preparations and recreational drugs, before and during DAA therapy. Given the large number of potential comedications and limited pharmacokinetic data in ESRD patients [19], DDIs have become a challenge in the era of DAAs in the clinical setting. Several studies have investigated potential DDIs with DAAs among the general population with HCV infection in clinical practice [20-22]. Nevertheless, comorbidities, comedications and potential DDIs in hepatitis C patients with ESRD on hemodialysis remain elusive. Apart from several new DAA regimens, which have been licensed for the treatment of HCV infection, the Food and Drug Administration (FDA) has recently amended the package inserts for sofosbuvir (SOF)-containing regimens to allow use in patients with an estimated glomerular filtration rate (eGFR) 30 mL/min and those on dialysis, based on validated safety and efficacy [23,24]. Updated information regarding the potential DDIs associated with these regimens is essential..