Impact of interferon‐free regimens on the glomerular filtration rate during treatment of chronic hepatitis C in a real‐life cohort

摘要

Summary Little data are available on renal toxicity exerted by direct‐acting antivirals ( DAA s) in real life. The aim of this study was to assess the impact of direct‐acting antivirals against hepatitis C virus infection currently used in Spain and Portugal on the estimated glomerular filtration rate ( eGFR ) in clinical practise. From an international, prospective multicohort study, patients treated with DAA s for at least 12?weeks and with eGFR ≥30?mL/min per 1.73?m 2 at baseline were selected. eGFR was determined using the CKD ‐ EPI formula. A total of 1131 patients were included; 658 (58%) were HIV / HCV ‐coinfected patients. Among the 901 patients treated for 12?weeks, median (interquartile range) eGFR was 100 (87‐107) at baseline vs 97 (85‐105) mL/min per 1.73?m 2 at week 12 of follow‐up ( FU 12) post‐treatment ( P ??.001). For HIV ‐coinfected subjects who received tenofovir plus a ritonavir‐boosted HIV protease inhibitor ( PI /r), baseline vs FU 12 eGFR were 104 (86‐109) vs 104 (91‐110) mL/min per 1.73?m 2 ( P ?=?.913). Among subjects receiving ombitasvir/paritaprevir with or without dasabuvir, eGFR did not show any significant change. Of 1100 subjects with eGFR 60?mL/min per 1.73?m 2 at baseline, 22 (2%) had eGFR 60?mL/min per 1.73?m 2 at FU 12, but none presented with eGFR 30?mL/min per 1.73?m 2 . In conclusion, eGFR slightly declines during therapy with all‐oral DAA s and this effect persists up to 12?weeks after stopping treatment in subjects with normal to moderately impaired renal function, regardless of HIV status. Concomitant use of tenofovir plus PI /r does not seem to have an impact on eGFR .