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Said M, Omar H, Soliman Z, Saad Y, Dabes H, Hamed S, ElSaeed K, ElShazly Y, ElSerafy M. Ritonavir-boosted paritaprevir, ombitasvir plus ribavirin could improve eGFR in patients with renal impairment and HCV: an Egyptian cohort. Expert Rev Gastroenterol Hepatol 2019; 13:89-93. [PMID: 30791838 DOI: 10.1080/17474124.2019.1544070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The present study aimed at evaluation of changes in estimated glomerular filtration rate (eGFR) among chronic Hepatitis C virus (HCV) patients with chronic kidney disease (CKD) Stages 3-5 who were treated with 12 weeks of ritonavir-boosted paritaprevir, ombitasvir plus ribavirin. METHODS Changes in renal functions were compared across follow up time points (baseline, SVR4, and SVR8). Data on on-treatment adverse events (AEs), serious AEs, laboratory abnormalities, treatment discontinuation were collected. RESULTS 171 patients were included (females 35%, mean age 53 years). 29 patients had liver cirrhosis. The most common etiologies of CKD were diabetes and/or hypertension (n = 67). All included patient reached the end of treatment (EOT) with no treatment discontinuations. The overall EOT response was 100%. 122/122 (100%) patients who reached 4 weeks post-treatment have achieved SVR4, and 80/80 (100%) have achieved SVR12. No reported SAEs. Ribavirin therapy was interrupted in 25% (43/171) of patients due to anemia; 16 patients required blood transfusions. The median eGFR improved from 33.5 (15) mL/min/1.73 m2 at baseline to 35 (36) mL/min/1.73 m2 at SVR8 (p = 0.0003). CONCLUSIONS The use of ombitasvir, paritaprevir, and ritonavir for treatment of HCV-infected patients with advanced renal disease was safe and effective, moreover, it was associated with significantly improved eGFR.
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Affiliation(s)
- Mohamed Said
- a Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Heba Omar
- a Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Zeinab Soliman
- a Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Yasmin Saad
- a Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Hosam Dabes
- b Internal Medicine Department , Damanhour Medical National Institute , Damanhour , Egypt
| | - Sozan Hamed
- b Internal Medicine Department , Damanhour Medical National Institute , Damanhour , Egypt
| | - Kadri ElSaeed
- c Internal Medicine Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt
| | - Yehia ElShazly
- c Internal Medicine Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt
| | - Magdi ElSerafy
- a Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine , Cairo University , Cairo , Egypt
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El Kassas M, Omran D, Elsaeed K, Alboraie M, Elakel W, El Tahan A, Abd El Latif Y, Nabeel MM, Korany M, Ezzat S, El-Serafy M, ElShazly Y, Doss W, Esmat G. Spur-of-the-Moment Modification in National Treatment Policies Leads to a Surprising HCV Viral Suppression in All Treated Patients: Real-Life Egyptian Experience. J Interferon Cytokine Res 2018; 38:81-85. [PMID: 29356573 DOI: 10.1089/jir.2017.0121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to retrospectively analyze the outcome of an unscheduled change in national Egyptian policies for the treatment of hepatitis C virus (HCV), which was transpired as a result of a reduction in interferon supplies, and to manage patients who already started interferon-based therapy. After completing a priming 4-weeks course of sofosbuvir/pegylated interferon/ribavirin (SOF/PEG IFN/RBV), a 12-weeks course of sofosbuvir/daclatasvir (SOF/DCV) combination was initiated. We evaluated the sustained virologic response at 12 weeks posttreatment (SVR12) for 2 groups of patients; Group 1, which included patients who had the previous regimen with IFN priming, and group 2, which included the first consecutive group of patients who received SOF/DCV for 12 weeks from the start without IFN priming. All group 1 patients (1,214 patients) achieved SVR12 (100%) and this was statistically significant when compared with the overall SVR12 in group 2 [8,869 patients with sustained virologic response [SVR] of 98.9%] (P value <0.001). No serious adverse events were reported in both groups. In this real-life treatment experience, interferon-based directly acting antiviral treatment with SOF/PEG IFN/RBV as a priming for 4 weeks, followed by SOF/DCV combination for 12 weeks, led to HCV viral suppression in all treated patients.
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Affiliation(s)
- Mohamed El Kassas
- 1 Endemic Medicine Department, Faculty of Medicine, Helwan University , Cairo, Egypt
| | - Dalia Omran
- 2 Endemic Medicine and Hepato-Gastroenterology Department, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Kadry Elsaeed
- 3 Internal Medicine Department, Ain Shams University , Cairo, Egypt
| | - Mohamed Alboraie
- 4 Department of Internal Medicine, Al-Azhar University , Cairo, Egypt
| | - Wafaa Elakel
- 2 Endemic Medicine and Hepato-Gastroenterology Department, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Adel El Tahan
- 5 New Cairo Viral Hepatitis Treatment Unit , Cairo, Egypt
| | - Yasmeen Abd El Latif
- 6 Tropical Medicine Department, Faculty of Medicine, Ain Shams University , Cairo, Egypt
| | - Mohamed Mahmoud Nabeel
- 2 Endemic Medicine and Hepato-Gastroenterology Department, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Mohamed Korany
- 7 Viral Hepatitis Treatment Unit, Cairo Fatemic Hospital , Cairo, Egypt
| | - Sameera Ezzat
- 8 Epidemiology and Preventive Medicine Department, National Liver Institute , Menoufia University, Menoufia, Egypt
| | - Magdy El-Serafy
- 2 Endemic Medicine and Hepato-Gastroenterology Department, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Yehia ElShazly
- 3 Internal Medicine Department, Ain Shams University , Cairo, Egypt
| | - Wahid Doss
- 2 Endemic Medicine and Hepato-Gastroenterology Department, Faculty of Medicine, Cairo University , Cairo, Egypt
| | - Gamal Esmat
- 2 Endemic Medicine and Hepato-Gastroenterology Department, Faculty of Medicine, Cairo University , Cairo, Egypt
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El-Akel W, El-Sayed MH, El Kassas M, El-Serafy M, Khairy M, Elsaeed K, Kabil K, Hassany M, Shawky A, Yosry A, Shaker MK, ElShazly Y, Waked I, Esmat G, Doss W. National treatment programme of hepatitis C in Egypt: Hepatitis C virus model of care. J Viral Hepat 2017; 24:262-267. [PMID: 28145032 DOI: 10.1111/jvh.12668] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023]
Abstract
Hepatitis C virus (HCV) infection is a major health problem in Egypt as the nation bears the highest prevalence rate worldwide. This necessitated establishing a novel model of care (MOC) to contain the epidemic, deliver patient care and ensure global treatment access. In this review, we describe the process of development of the Egyptian model and future strategies for sustainability. Although the magnitude of the HCV problem was known for many years, the HCV MOC only came into being in 2006 with the establishment of the National Committee for Control of Viral Hepatitis (NCCVH) to set up and implement a national control strategy for the disease and other causes of viral hepatitis. The strategy outlines best practices for patient care delivery by applying a set of service principles through identified clinical streams and patient flow continuums. The Egyptian national viral hepatitis treatment programme is considered one of the most successful and effective public health programmes. To date, more than one million patients were evaluated and more than 850 000 received treatment under the umbrella of the programme since 2006. The NCCVH has been successful in establishing a strong infrastructure for controlling viral hepatitis in Egypt. It established a nationwide network of digitally connected viral hepatitis-specialized treatment centres covering the country map to enhance treatment access. Practice guidelines suiting local circumstances were issued and regularly updated and are applied in all affiliated centres. This review illustrates the model and the successful Egyptian experience. It sets an exemplar for states, organizations and policy-makers setting up programmes for care and management of people with hepatitis C.
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Affiliation(s)
- W El-Akel
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M H El-Sayed
- Pediatrics (Hematology/Oncology), Ain Shams University, Cairo, Egypt
| | - M El Kassas
- Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - M El-Serafy
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M Khairy
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - K Elsaeed
- Internal Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - K Kabil
- New Pediatric Children Hospital, Cairo University, Cairo, Egypt
| | - M Hassany
- Department of Tropical Diseases, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - A Shawky
- Internal Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - A Yosry
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M K Shaker
- Tropical Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Y ElShazly
- Internal Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - I Waked
- Department of Hepatology, National Liver Institute, Shebin El-Kom, Egypt
| | - G Esmat
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - W Doss
- Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Eletreby R, Elakel W, Said M, El Kassas M, Seif S, Elbaz T, El Raziky M, Abdel Rehim S, Zaky S, Fouad R, Gamal Eldeen H, Abdo M, Korany M, Yosry A, El Serafy M, El-Sayed MH, ElShazly Y, Waked I, Doss W, Esmat G. Real life Egyptian experience of efficacy and safety of Simeprevir/Sofosbuvir therapy in 6211 chronic HCV genotype IV infected patients. Liver Int 2017; 37:534-541. [PMID: 27712017 DOI: 10.1111/liv.13266] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Major changes have emerged during the last few years in the therapy of chronic HCV. Several direct acting antiviral agents have been developed showing potent activity with higher rates of sustained virological response, even in difficult-to-treat patients. This study explores real life experience concerning efficacy, safety and possible predictors of response for the first cohort of Egyptian patients with chronic HCV genotype IV treated with Sofosbuvir/Simprevir combination therapy. METHODS This real life study recruited the first (6211) chronic HCV genotype IV Egyptian patients, who received antiviral therapy in viral hepatitis specialized treatment centres affiliated to the National committee for control of viral hepatitis. All enrolled patients received 12 weeks course of daily combination of sofosbuvir (400 mg) and simeprevir (150 mg). Patients were closely monitored for treatment safety and efficacy. RESULTS Overall sustained virological response 12 rate was 94.0% while the end of treatment response rate was 97.6%. sustained virological response 12 rates in easy and difficult-to-treat groups were 96% and 93% respectively. Univariate and multivariate logistic regression analysis revealed significant association of low albumin (<3.5), cirrhosis and Fib-4 score (>3.25) with treatment failure. Fatal adverse events occurred in 23/6211 cases (0.37%) due to liver cell failure adverse events or SAEs leading to treatment discontinuation occurred in 97 patients (1.6%). CONCLUSION Sofosbuvir/Simeprevir combination is an effective and well tolerated regimen for patients with chronic HCV genotype IV.
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Affiliation(s)
- Rasha Eletreby
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Wafaa Elakel
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Mohamed Said
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
| | | | - Sameh Seif
- National Hepatology & Tropical Medicine Research Institute, Cairo, Egypt
| | - Tamer Elbaz
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Maissa El Raziky
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Siham Abdel Rehim
- Tropical Medicine Department, Alexandria University, Alexandria, Egypt
| | - Samy Zaky
- Tropical Medicine Department, El Azhar University, Cairo, Egypt
| | - Rabab Fouad
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
| | | | - Mahmoud Abdo
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
| | | | - Ayman Yosry
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Magdy El Serafy
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
| | | | - Yehia ElShazly
- Internal Medicine Department, Ain Shams University, Cairo, Egypt
| | - Imam Waked
- National liver institute, Shebeen El Kom, Menoufia, Egypt
| | - Wahid Doss
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Gamal Esmat
- Hepatology & Endemic Medicine Department, Cairo University, Cairo, Egypt
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