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Rotea-Salvo S, Martínez-Pradeda A, Fernández-Oliveira C, Giménez-Arufe V, Balboa-Barreiro V, Margusino-Framiñán L, Mena-De-Cea Á, Vázquez-Rodríguez P, Castro-Iglesias Á, López-Calvo S, Martín-Herranz I, Míguez-Rey E, Cid-Silva P. Renal profile of patients treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine: 120-week results from a real-world cohort. Eur J Hosp Pharm 2023; 30:221-226. [PMID: 34649965 PMCID: PMC10359784 DOI: 10.1136/ejhpharm-2021-002896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/28/2021] [Indexed: 11/03/2022] Open
Abstract
Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate (EVG/c/FTC/TAF) and dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) are currently available for HIV patients. OBJECTIVES This study evaluated modifications in the renal safety profile in a large real-world cohort of patients who had received EVG/c/FTC/TAF or DTG/ABC/3TC. METHODS A retrospective observational study of HIV-infected patients who received EVG/c/FTC/TAF or DTG/ABC/3TC between March 2015 and June 2019 at a reference hospital in north-western Spain was conducted. Epidemiological, clinical, immunovirological data and information regarding antiretroviral therapy were recorded. The statistical differences between treatments were calculated. RESULTS A total of 457 patients were evaluated, 266 using EVG/c/FTC/TAF and 191 using DTG/ABC/3TC. Up to week 120, serum creatinine improved in both study groups among experienced patients (EVG/c/FTC/TAF 1.01±0.24 vs 0.91±0.19, p<0.001; DTG/ABC/3TC 1.08±0.24 vs 1.02±0.31, p<0.001), while in naïve patients serum creatinine remained stable compared with baseline. Statistically significant differences were found in serum creatinine when comparing both treatments at week 48 in experienced (0.94±0.21 vs 1.09±0.28, p<0.001) and naïve patients (0.89±0.16 vs 1.06±0.20, p=0.001), and among experienced patients at week 120 (0.91±0.19 vs 1.02±0.31, p=0.015) for the EVG/c/FTC/TAF and DTG/ABC/3TC groups, respectively. During the follow-up, 39 patients in EVG/c/FTC/TAF and 33 in DTG/ABC/3TC (p=0.449) discontinued treatment. The main reason for stopping treatment was adverse events, which were similar in both groups. CONCLUSIONS During the follow-up, patients experienced changes that were not clinically relevant in both treatment groups. Differences in renal events were not found.
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Affiliation(s)
- Sandra Rotea-Salvo
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | | | - Carla Fernández-Oliveira
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Victor Giménez-Arufe
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Vanesa Balboa-Barreiro
- Clinical Epidemiology and Biostatistics Unit, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
| | - Luis Margusino-Framiñán
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
| | - Álvaro Mena-De-Cea
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Pilar Vázquez-Rodríguez
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Ángeles Castro-Iglesias
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Soledad López-Calvo
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Isabel Martín-Herranz
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Enrique Míguez-Rey
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Purificación Cid-Silva
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
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Margusino-Framiñán L, Cid-Silva P, Giménez-Arufe V, Mondelo-García C, Fernández-Oliveira C, Mena-de-Cea Á, Martín-Herranz I, Castro-Iglesias Á. Influence of drug-drug interactions on effectiveness and safety of direct-acting antivirals against hepatitis C virus. Eur J Hosp Pharm 2021; 28:16-21. [PMID: 33355279 PMCID: PMC7788226 DOI: 10.1136/ejhpharm-2019-001889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/12/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Direct-acting antivirals are the recommended treatment for hepatitis C-infected patients. Drug-drug interactions with concomitant treatments can cause lack of effectiveness and/or safety. The objective of this study is to characterise drug-drug interactions of direct-acting antivirals and to analyse their influence both on the effectiveness of antiviral treatment and on the overall safety of pharmacological treatment in hepatitis C-infected patients. METHODS Observational and prospective cohort study for 3 years in the pharmaceutical care outpatient consultation of a general hospital, undertaking detection, evaluation and management of drug-drug interactions by clinical pharmacists and physicians. The main outcome measures were sustained virologic response at week 12 for effectiveness and serious drug-related adverse events for safety. Multivariate statistical analysis applied to: (a) patient basal characteristics related to presence of drug-drug interactions; (b) previous antiviral treatments, viral genotype, cirrhosis, decompensations and presence of drug-drug interactions related to the effectiveness of direct-acting antivirals. RESULTS Of a total of 1092 patients, the majority of them were men, around 60 years old and HCV-genotype 1 mono-infected, with a high basal viral load, naive to antiviral treatment, treated with ledipasvir/sofosbuvir and without cirrhosis. 24.5% had drug-drug interactions. Proton pump inhibitors were the concomitant drugs that caused the most drug-drug interactions. Age ≥65 years and direct-acting antivirals based on protease inhibitors were independently related to the presence of drug-drug interactions (p≤0.012). All (100%) of the therapeutic recommendations based on detected drug-drug interactions were implemented; 97.7% of patients with interactions versus 99.0% without them reached sustained virologic failure (p=0.109). The serious adverse events rates were 1.5% and 1.3% in patients with and without drug-drug interactions, respectively (p=0.841). CONCLUSIONS Drug-drug interactions are frequent among hepatitis C-infected patients receiving treatment with direct-acting antivirals. However, the collaboration between physicians and clinical pharmacists makes it possible to detect, evaluate, avoid or clinically manage these drug-drug interactions, in order to maintain whole treatment therapeutic safety and the effectiveness of direct-acting antivirals.
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Affiliation(s)
- Luis Margusino-Framiñán
- Pharmacy Service, Universitary Hospital of A Coruña, A Coruña, Spain
- Division of Clinical Virology, BiomedicalResearch Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña(CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain
| | - Purificación Cid-Silva
- Pharmacy Service, Universitary Hospital of A Coruña, A Coruña, Spain
- Division of Clinical Virology, BiomedicalResearch Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña(CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain
| | | | | | | | - Álvaro Mena-de-Cea
- Division of Clinical Virology, BiomedicalResearch Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña(CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain
- Infectious Disease Unit. Internal Medicine Service, Universitary Hospital of A Coruña, A Coruña, Spain
| | | | - Ángeles Castro-Iglesias
- Division of Clinical Virology, BiomedicalResearch Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña(CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain
- Infectious Disease Unit. Internal Medicine Service, Universitary Hospital of A Coruña, A Coruña, Spain
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