1
|
Attia D, El Saeed K, Elakel W, El Baz T, Omar A, Yosry A, Elsayed MH, Said M, El Raziky M, Anees M, Doss W, El Shazly Y, Wedemeyer H, Esmat G. The adverse effects of interferon-free regimens in 149 816 chronic hepatitis C treated Egyptian patients. Aliment Pharmacol Ther 2018; 47:1296-1305. [PMID: 29504152 DOI: 10.1111/apt.14538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/30/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Interferon-free regimens are associated with high sustained virological response; however, associated adverse effects have yet to be fully reported. AIM To evaluate the adverse effects associated with the different direct-acting antiviral drug (DAA) regimens in Egyptian patients. METHODS This multicenter retrospective study included all adverse effects during and after treatment with DAA regimens of 149 816 chronic hepatitis C treated Egyptian patients. Patients received sofosbuvir (SOF)/ribavirin (RBV) (n = 21 835), SOF/simeprevir (n = 24 215) SOF/daclatasvir (DCV) (n = 58 477), SOF/DCV/RBV (n = 45 188) and paritaprevir/ombitasvir/ritonavir/RBV (n = 101). The duration of treatment varied between 12 and 24 weeks. All changes in the treatment regimens, discontinuation, mortality, and serious side effects were reported. RESULTS Adverse effects developed in 2475 (1.7%) (mean age [54 ± 9], male gender [53%]) patients. Serious side effects developed in 68% of these patients, and SOF/RBV was the most common causing regimen (73%, P < 0.001). Anaemia and hyperbilirubinemia were the most common side effects (731/149816, 0.5% and 463/149816, 0.3%, respectively) and SOF/RBV (588/21835, 3% and 353/21835, 1.6%, respectively) showed the highest incidence in the treated patients. Hepatocellular carcinoma and mortality were reported in 0.02% and 0.06% of all treated patients, respectively. Patients with liver cirrhosis showed higher incidence of serious side effects (Log rank P = 0.045) and mortality (Log rank P = 0.025) than patients without liver cirrhosis. Male gender (P = 0.012), lower haemoglobin (P < 0.001), platelets (P < 0.001) and albumin (P = 0.001), higher bilirubin (P = 0.002) and cirrhosis (P < 0.001) were factors associated with serious side effects development. CONCLUSION Adverse effects associated with DAAs are few, anaemia being the most common. SOF/RBV regimen showed the highest rate of side effects while SOF/DCV showed the least.
Collapse
Affiliation(s)
- D Attia
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Beni-suef University, Beni-suef, Egypt
| | - K El Saeed
- Department of Tropical Medicine, Ain Shams University, Cairo, Egypt
| | - W Elakel
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - T El Baz
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A Omar
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A Yosry
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M H Elsayed
- National Committee of Viral Hepatitis MOH, Ain Shams University, Cairo, Egypt
| | - M Said
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M El Raziky
- Department of Hepatology, Gastroenterology and Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M Anees
- Department of Tropical Medicine, Tanta University, Tanta, Egypt
| | - W Doss
- National Committee of Viral Hepatitis MOH, Cairo University, Cairo, Egypt
| | - Y El Shazly
- National Committee of Viral Hepatitis MOH, Ain Shams University, Cairo, Egypt
| | - H Wedemeyer
- Department of Hepatology, Gastroenterology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - G Esmat
- National Committee of Viral Hepatitis MOH, Cairo University, Cairo, Egypt
| |
Collapse
|
2
|
El-Khayat HR, Kamal EM, El-Sayed MH, El-Shabrawi M, Ayoub H, RizK A, Maher M, El Sheemy RY, Fouad YM, Attia D. The effectiveness and safety of ledipasvir plus sofosbuvir in adolescents with chronic hepatitis C virus genotype 4 infection: a real-world experience. Aliment Pharmacol Ther 2018; 47:838-844. [PMID: 29349793 DOI: 10.1111/apt.14502] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/10/2017] [Accepted: 12/11/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The combination of ledipasvir plus sofosbuvir was recently approved for treatment of adolescent (12-17 years) HCV genotype 1, 4, 5 & 6 patients. However, few clinical trials have been performed in genotype 1 patients. AIM To investigate the effectiveness and safety of ledipasvir plus sofosbuvir in chronic HCV adolescent patients with genotype 4 in the real world. METHODS This prospective multicentre (six centres) open-label study included 144 adolescent chronic HCV patients with genotype 4 (mean age 14 ± 2, 69% males). All patients received a combination tablet containing 400 mg sofosbuvir and 90 mg ledipasvir once daily for 12 weeks. Laboratory and virological markers were evaluated at baseline, week 4, week 8 and week 12 (EOT), and 12 weeks after end of treatment (SVR12). RESULTS SVR12 was observed in 142/144 patients (99%). The relapsers occurred in previous naïve patients (n = 2/128, 2%), while the experienced patients showed 100% SVR12. SVR12 was 98% in F0/F1 patients in comparison to 100% in F2 patients (P = 0.552). No serious side effects were observed, nor was treatment discontinuation or death. Headache was the most common side effect in all patients (20%). In experienced patients, pruritus (31%, P = 0.007), diarrhoea (44%, P < 0.001) and skin rash (19%, P = 0.002) were higher than in naïve patients. CONCLUSIONS A ledipasvir plus sofosbuvir regimen is well tolerated and effective, and can be used safely in treating adolescent patients with chronic hepatitis C genotype 4.
Collapse
Affiliation(s)
- H R El-Khayat
- Department of Gastroenterology, Hepatology and Endemic Medicine, Theodore Bilharz Research Institute, Cairo, Egypt
| | - E M Kamal
- Department of Gastroenterology, Hepatology and Endemic Medicine, Minia University Hospitals, Minia, Egypt
| | - M H El-Sayed
- Rheumatology Department, Cairo University Hospitals, Cairo, Egypt
| | - M El-Shabrawi
- Rheumatology Department, Cairo University Hospitals, Cairo, Egypt
| | - H Ayoub
- Department of Gastroenterology, Hepatology and Endemic Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - A RizK
- Rheumatology Department, Cairo University Hospitals, Cairo, Egypt
| | - M Maher
- Department of Gastroenterology, Hepatology and Endemic Medicine, Egyptian Military Academy, Cairo, Egypt
| | - R Y El Sheemy
- Department of Gastroenterology, Hepatology and Endemic Medicine, Minia University Hospitals, Minia, Egypt
| | - Y M Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Minia University Hospitals, Minia, Egypt
| | - D Attia
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni-suef University, Beni-suef, Egypt
| |
Collapse
|
3
|
Attia D, Bantel H, Lenzen H, Manns MP, Gebel MJ, Potthoff A. Liver stiffness measurement using acoustic radiation force impulse elastography in overweight and obese patients. Aliment Pharmacol Ther 2016; 44:366-79. [PMID: 27363528 DOI: 10.1111/apt.13710] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 02/28/2016] [Accepted: 06/08/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity and overweight are global health problems. AIM To evaluate the diagnostic accuracy of liver stiffness measurement (LSM) using acoustic radiation force impulse (ARFI) elastography in overweight and obese patients for staging liver fibrosis. METHODS Ninety-seven patients (mean age: 50 years, 50% male) with body mass index (BMI) ≥25 kg/m(2) (mean BMI: 31 kg/m(2) ) were prospectively enrolled. All patients underwent ARFI elastography and liver biopsy. In 87/97 patients, transient elastography (TE) was performed (M- and XL-probes). Patients were divided into two groups respectively: overweight: BMI <30 kg/m(2) (n = 61); and obese: BMI ≥30 kg/m(2) (n = 26). RESULTS Acoustic radiation force impulse elastography correlated with liver fibrosis in overweight (r = 0.84, P < 0.0001) and obese patients (r = 0.85, P < 0.0001), while no correlation was observed with steatosis, steatohepatitis and BMI. Area under the curve detecting liver cirrhosis for ARFI and TE were 0.97 in overweight and 0.94 and 0.92 in obese patients. In both groups, the failure rate was lower for ARFI than TE. ARFI of liver segment 8 showed a lower discordance than TE in both groups (overweight: 3% vs. 12%, P = 0.002; obese: 8% vs. 27%, P = 0.034). Steatosis and steatohepatitis were neither predictors of discordance nor of performance in LSM by ARFI or TE in both groups. CONCLUSIONS In overweight and obese patients, acoustic radiation force impulse can diagnose liver cirrhosis and significant fibrosis with high diagnostic accuracy. Liver stiffness measurement using the XL-probe reduces the influence of BMI, steatosis and steatohepatitis. The failure and discordance rates were lower for acoustic radiation force impulse than transient elastography in both patients groups.
Collapse
Affiliation(s)
- D Attia
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
| | - H Bantel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - H Lenzen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - M P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - M J Gebel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - A Potthoff
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
4
|
Attia D, Schoenemeier B, Rodt T, Negm AA, Lenzen H, Lankisch TO, Manns M, Gebel M, Potthoff A. Evaluation of Liver and Spleen Stiffness with Acoustic Radiation Force Impulse Quantification Elastography for Diagnosing Clinically Significant Portal Hypertension. Ultraschall Med 2015; 36:603-610. [PMID: 26565516 DOI: 10.1055/s-0041-107971] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Hepatic vein pressure gradient (HVPG) is the gold standard for diagnosing clinically significant portal hypertension (CSPH). The aim of this study was to investigate-in comparison to HVPG-the ability to diagnose CSPH by liver and spleen stiffness measurements obtained by acoustic radiation force impulse (ARFI) imaging. MATERIALS AND METHODS A total of 78 patients (mean age: 53 ± 13 years, 62 % male) with chronic liver disease were enrolled in this study. Each patient received liver (LSM) and spleen (SSM) stiffness measurements by ARFI, an HVPG measurement and a transjugular liver biopsy on the same day. Patients were classified according to their HVPG into three different groups: HVPG < 10 mmHg, HVPG ≥ 10-< 12 mmHg and HVPG ≥ 12 mmHg. RESULTS LSM, SSM were significantly higher in patients with HVPG ≥ 10 - < 12 in comparison to HVPG < 10 mmHg (p < 0.001 and p < 0.001, respectively), and in patients with HVPG ≥ 12 mmHg in comparison to ≥ 10 - < 12 mmHg (p < 0.001 and p < 0.001, respectively). LSM and SSM were able to diagnose HVPG ≥ 10 mmHg and HVPG ≥ 12 mmHg with high diagnostic performance (AUC LSM: 0.93 and 0.87, respectively; AUC SSM: 0.97 and 0.95, respectively). The AUC of SSM in predicting esophageal varices (EVs) plus HVPG ≥ 10 mmHg and EVs plus HVPG ≥ 12 mmHg were higher compared to LSM in both groups of patients (SSM: 0.90 and 0.93 vs. LSM: 0.84 and 0.88, respectively). No significant difference between both AUCs was detected in the different HVPG groups. In the multivariate -analysis SSM remained a factor predicting HVPG (HVPG > 10 mmHg p = 0.007; HVPG ≥ 12 mmHg p = 0.003). CONCLUSION LSM and SSM by ARFI are noninvasive diagnostic tools that may help in diagnosing CSPH. LSM and SSM could be used as a guiding noninvasive screening tool in patients with esophageal varices requiring endoscopic evaluation.
Collapse
Affiliation(s)
- D Attia
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - B Schoenemeier
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - T Rodt
- Hannover Medical School, Diagnostic and Interventional Radiology, Hannover, Germany
| | - A A Negm
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - H Lenzen
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - T O Lankisch
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - M Manns
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - M Gebel
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - A Potthoff
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| |
Collapse
|
5
|
Attia D, Gheita T, El Awar A, Abd Alaal A, Ayoub M. AB0619 Isotypes of Anti-Beta 2- Glycoprotein I in Systemic Lupus Erythematosus Patients: Correlation with Clinical Manifestations, Laboratory Features and Association with Antiphospholipid Syndrome. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
6
|
Behar-Cohen F, Martinsons C, Viénot F, Zissis G, Barlier-Salsi A, Cesarini JP, Enouf O, Garcia M, Picaud S, Attia D. Light-emitting diodes (LED) for domestic lighting: any risks for the eye? Prog Retin Eye Res 2011; 30:239-57. [PMID: 21600300 DOI: 10.1016/j.preteyeres.2011.04.002] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 04/21/2011] [Accepted: 04/29/2011] [Indexed: 12/11/2022]
Abstract
Light-emitting diodes (LEDs) are taking an increasing place in the market of domestic lighting because they produce light with low energy consumption. In the EU, by 2016, no traditional incandescent light sources will be available and LEDs may become the major domestic light sources. Due to specific spectral and energetic characteristics of white LEDs as compared to other domestic light sources, some concerns have been raised regarding their safety for human health and particularly potential harmful risks for the eye. To conduct a health risk assessment on systems using LEDs, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), a public body reporting to the French Ministers for ecology, for health and for employment, has organized a task group. This group consisted physicists, lighting and metrology specialists, retinal biologist and ophthalmologist who have worked together for a year. Part of this work has comprised the evaluation of group risks of different white LEDs commercialized on the French market, according to the standards and found that some of these lights belonged to the group risk 1 or 2. This paper gives a comprehensive analysis of the potential risks of white LEDs, taking into account pre-clinical knowledge as well as epidemiologic studies and reports the French Agency's recommendations to avoid potential retinal hazards.
Collapse
Affiliation(s)
- F Behar-Cohen
- Inserm UMRS 872, Physiopathology of Ocular Diseases: Therapeutic Innovations, Centre de Recherche des Cordeliers, Paris, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Nordin JY, Attia D. [Fractures of the upper end of the femur in adults. Etiology, mechanism, diagnosis, development, prognosis, treatment]. Rev Prat 1993; 43:223-8. [PMID: 8502945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J Y Nordin
- Service d'orthopédie et traumatologie, hôpital Avicenne, Bobigny
| | | |
Collapse
|
8
|
de Gennes C, Le Thi Huong DU, Raguin G, Godeau P, Attia D, Bousquet JC. [Tropical myositis simulating arthritis of the hip]. Rev Rhum Mal Osteoartic 1990; 57:238-9. [PMID: 2339275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|