Evolution of glomerular filtration rates and neutrophil gelatinase-associated lipocalin during treatment with direct acting antivirals

Strazzulla, Alessio; Coppolino, Giuseppe; Barreca, Giorgio Settimo; Gentile, I.; Rivoli, Laura; Postorino, Maria Concetta; Mazzitelli, Maria; Greco, G.; Costa, Cristina; Pisani, Vincenzo; Marascio, Nadia; Simeoni, Mariadelina; Focà, Alfredo; Fuiano, Giorgio; Foti, Daniela; Gulletta, Elio; Torti, Carlo

doi:10.3350/cmh.2017.0059

Cited by 15 publications

(17 citation statements)

References 30 publications

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“…All these characteristics (advanced age, comorbidities, and high burden of comedications) could potentially affect tolerability of HCV treatment and adherence in this subgroup [7]. Moreover, some possible side effects and biomarker alterations, as well as increased risk of liver cancer, have been reported by several authors, especially in elderly people [8][9][10][11][12][13]. In addition, the presence of some side effects was in particular reported among those who had concurrent comorbidities (such as liver cirrhosis, cardiac failure, and advanced age) [14,15].…”

Section: Introductionmentioning

confidence: 96%

Virological and Clinical Outcome of DAA Containing Regimens in a Cohort of Patients in Calabria Region (Southern Italy)

et al. 2020

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Background and objectives: In Italy, Hepatitis C Virus (HCV) infections are most prevalent in people older than 50 years of age, who often experience multi-morbidities, take co-medications, and have a long history of liver disease. These characteristics could potentially affect tolerability of HCV treatments and adherence in this subgroup. After achievement of sustained virological response (SVR), retention into care is very important both to detect the onset of possible complications and prevent further infections. In this study, SVR rates and retention into care of patients treated with directly acting antivirals (DAAs) of a single-center cohort in Southern Italy were evaluated. Materials and Methods: Patients treated with directly acting antivirals from 2014 to 2018 were included. Patients were stratified by age (i.e., <65 vs. ≥65 years) and by cirrhosis presence (i.e., liver stiffness >14.6 KPa or clinical/ultrasound cirrhosis vs. absence of these criteria). Primary outcome was availability of SVR at Weeks 12-24 after the end of treatment. Inter-and intra-group comparisons were performed along the follow-up for significant laboratory parameters. Results: In total, 212 patients were treated; 184 (87%) obtained SVR after the first treatment course and 4 patients after retreatment. Twenty-two (10.4%) patients were lost to follow-up before assessment of SVR, and two patients died before the end of treatment for liver decompensation. Considering only the first treatment episode, per protocol analysis (i.e., excluding patients lost to follow-up) showed the following rates of SVR: 97% (overall), 97% (older age group), 96% (age group <65 years), 94% (cirrhotics), and 100% (non-cirrhotics). By contrast, at the intention to treat analysis (i.e., patients lost were computed as failures), SVR percentages were significantly lower for patients <65 years of age (80%) and for non-cirrhotics (85%). Conclusions: High rates of SVR were obtained. However, younger patients and those without cirrhosis displayed an apparent high risk of being lost to follow-up. This may have important implications: since those who are lost may transmit HCV in case SVR is not achieved, these subpopulations should receive appropriate counselling during treatment.

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Section: Introductionmentioning

confidence: 96%

Virological and Clinical Outcome of DAA Containing Regimens in a Cohort of Patients in Calabria Region (Southern Italy)

et al. 2020

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“…It has been suggested that DAA therapy may have transient negative impacts on renal function. 33,34 We observed that the renal function was not affected at 3 months after the end of treatment, compared to the pretreatment levels, thus indicating that the modification of SUA was not affected by the change in renal function in this study.…”

Section: Discussionmentioning

confidence: 50%

Improvement of hyperuricemia in chronic hepatitis C patients receiving directly acting antiviral agents

Jang

Huang

Yeh

et al. 2019

J of Gastro and Hepatol

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Background and Aim Hepatitis C virus eradication via the use of antivirals ameliorates metabolic profiles. The changes in serum uric acid (SUA) levels in chronic hepatitis C patients who receive antivirals are not well understood. We aimed to address this issue by comparing the SUA changes before and after the achievement of a sustained virological response (which is defined as hepatitis C virus RNA seronegativity at 12 weeks after the end of treatment). Methods Two hundred and thirteen sustained virological response patients who were treated by directly acting antivirals were consecutively enrolled. Pretreatment and post‐treatment SUA levels were compared. Hyperuricemia was defined as a uric acid level > 7.0 mg/dL in men and > 6.0 mg/dL in women. Results The SUA levels significantly decreased after treatment, as compared to the pretreatment levels (5.6 ± 1.5 vs 6.0 ± 1.7 mg/dL, respectively; P < 0.001). The proportion of hyperuricemia incidences significantly decreased after treatment (25.8% vs 35.7%, respectively; P = 0.001). The improvement was only observed in patients with a fibrosis‐4 index (FIB‐4) < 6.5 (25.7% vs 37.1%, P = 0.001) but not in those patients with a FIB‐4 ≧ 6.5 (26.3% vs 28.9%, P = 1.00). A multivariate analysis revealed that the factor that was associated with significantly decreased SUA levels was FIB‐4 < 6.5 (odds ratio [OR]/95% confidence interval [CI]: 3.22/1.04–9.95, P = 0.04) and estimated glomerular filtration rate < 60 mL/min/1.73 m2 (OR/CI: 4.34/1.94–9.73, P < 0.001). There existed a trend of a higher proportion of patients with significant SUA improvement along with the decrement of FIB‐4 (29.7%, 25%, and 10.5% in patients with FIB‐4 < 3.25, 3.25–6.5, and > 6.5, respectively; trend P = 0.03). Conclusions SUA levels were significantly decreased in chronic hepatitis C patients after viral eradication. The improvement was particularly enhanced in patients with mild liver disease.

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“…e recent availability of direct-acting antivirals (DAAs) has led to a revolution in the treatment of HCV infections, being a highly effective treatment option irrespective of the stage of liver fibrosis [15]. However, there have been concerns about renal function deterioration associated with DAAs [5].…”

Section: Discussionmentioning

confidence: 99%

“…To date, only one study conducted by Strazzulla et al attempted to retrospectively investigate the role of NGAL in evaluating the effect of sofosbuvir-based antivirals on renal tubules, in 18 patients with chronic HCV infection. No large prospective studies have been published about this issue [5]. Hence, this study aimed to assess serum NGAL both before and after the twelve weeks of therapy with sofosbuvir-based regimen, in a larger population of HCV RNA-positive patients.…”

Section: Discussionmentioning

confidence: 99%

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Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in HCV-Positive Egyptian Patients Treated with Sofosbuvir

Nada

Abbasy

Sabry

et al. 2020

Canadian Journal of Gastroenterology and Hepatology

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Background. Direct-acting antivirals (DAAs) made a drastic change in the management of HCV infection. Sofosbuvir is one of the highly potent DAAs, eliminated mainly through the kidney. But concerns about renal safety during treatment may limit its use. Neutrophil gelatinase-associated lipocalin (NGAL) has been proven as a predictor of renal tubular injury. Hence, the aim of this work was to assess serum neutrophil gelatinase-associated lipocalin (NGAL) in HCV-positive patients before and after treatment with the sofosbuvir-based antiviral regimen. Methods. This prospective study included 87 Egyptian patients with chronic HCV infection treated with sofosbuvir plus daclatasvir with or without ribavirin for 12 weeks. Serum NGAL was measured before and at the end of treatment (EOT). Analysis of NGAL and estimated glomerular filtration rate (eGFR) evolution was done. Results. Our results showed a statistically significant decrease in serum NGAL (P=0.02) with a nonsignificant reduction in eGFR (P=0.06). Moreover, changes in serum NGAL levels (baseline compared to EOT) in patients ranked by KDIGO-CKD classification showed a significant decrease in stages 1 and 2 (P=0.14 and 0.034, respectively) and a nonsignificant decrease in stage 3 (P=0.25). Also, eGFR changes after treatment in patients ranked by the same classifications showed a nonsignificant reduction in all stages (P>0.05). Conclusions. Sofosbuvir appears to have no nephrotoxic effects and is safe to treat patients with chronic HCV infection.

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Evolution of glomerular filtration rates and neutrophil gelatinase-associated lipocalin during treatment with direct acting antivirals

Cited by 15 publications

References 30 publications

Virological and Clinical Outcome of DAA Containing Regimens in a Cohort of Patients in Calabria Region (Southern Italy)

Virological and Clinical Outcome of DAA Containing Regimens in a Cohort of Patients in Calabria Region (Southern Italy)

Improvement of hyperuricemia in chronic hepatitis C patients receiving directly acting antiviral agents

Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) in HCV-Positive Egyptian Patients Treated with Sofosbuvir

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