Direct-Acting Antiviral Therapy Safe for Treating Chronic Hepatitis C Despite Reduced eGFR

Direct-acting antiviral (DAA)-based therapy has demonstrated safety in treating those with chronic hepatitis C, despite slight regressions in renal function between baseline and end of treatment, according to a study recently published in Journal of Viral Hepatitis. Those who are older than 65 years, have had a liver transplant, or have a baseline estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m² are particularly vulnerable to renal deterioration.

This retrospective cohort study included data from 1536 DAA-naive individuals with chronic hepatitis C, 835 of whom were treated with paritaprevir/ritonavir/ombitasvir/dasabuvir (PrOD), 265 with daclatasvir/asunaprevir (DCV/ASV), 218 with sofosbuvir, and 218 with grazoprevir/elbasvir (GZP/EBV). All treatment was performed in the Chang Gung Medical Hospital in Taiwan, with eGFR used to assess renal function (measurements taken 6 to 12 months pretreatment, at baseline, at end of treatment, and at 12 weeks after end of treatment). The chi-squared test and analysis of variance were used to compare categorical and continuous variables among the 4 groups, with multivariate regression used to identify risk factors for deterioration of renal function.

Among the entire cohort, eGFR decreased significantly between baseline and end of treatment, from 84.8±25.3 to 81.8±26.1 mL/min/1.73 m² (P <.001), followed by a slight rise at week 12 post-treatment (83.8±26.7 mL/min/1.73 m²). Although the PrOD, GZP/EBV, and DCV/ASV groups showed similar trends, the sofosbuvir group showed a similar decrease in eGFR from baseline to end of treatment (P =.039) and from baseline to week 12 post-treatment (P =.017). Risk factors for deteriorating renal function were determined to be liver transplantation (odds ratio [OR] 3.894; 95% CI, 1.810-8.377; P =.001), age >65 years (OR 1.862; 95% CI, 1.152-3.009; P =.011), and baseline eGFR of at least 60 mL/min/1.73 m² (OR 2.684; 95% CI, 1.145-6.290; P =.023).

Limitations to this study include a retrospective design, selection bias, a lack of long-term data on DAA’s effects on renal function, potential inability of the Modification of Diet in Renal Disease formula to detect stage 1 or 2 chronic kidney disease, insufficient data on proteinuria, and unavailable data on certain confounders.

The study researchers conclude that current DAA-based therapy is safe for individuals with chronic hepatitis C. A slight rise in renal function was observed at end of treatment, followed by a slight decrease 12 weeks after end of treatment. The risk for deterioration of renal function is higher among those with a baseline eGFR ≥60 mL/min/1.73 m², those with a liver transplant, or those >65 years old. The researchers indicated that these individuals should be monitored closely while undergoing DAA treatment.

Reference

Tsai MC, Lin CY, Hung CH, et al. Evolution of renal function under directly acting antivirals treatment for chronic hepatitis C: a real world experience [published online August 21, 2019]. J Viral Hepat. doi: 10.1111/jvh.13193