慢性肾脏病患者中直接抗病毒药物的长期疗效评估：一项单中心队列研究

Evaluation of Long-Term Outcomes of Direct Acting Antiviral Agents in Chronic Kidney Disease Subjects: A Single Center Cohort Study.

作者信息

Czarnecka Paulina, Czarnecka Kinga, Tronina Olga, Bączkowska Teresa, Wyczałkowska-Tomasik Aleksandra, Durlik Magdalena, Czerwinska Katarzyna

机构信息

Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland.

Department of Immunology, Transplant Medicine and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland.

出版信息

J Clin Med. 2023 May 17;12(10):3513. doi: 10.3390/jcm12103513.

DOI:10.3390/jcm12103513

PMID:37240622

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10219487/

Abstract

BACKGROUND

The chronic kidney disease (CKD) population, including kidney transplant recipients (KTRs) and subjects on renal replacement therapy, is particularly vulnerable to unfavorable outcomes from chronic hepatitis C (CHC). Currently, there are oral direct-acting antiviral agents (DAAs) available to eradicate the virus with favorable short-term outcomes; however, their long-term effects are lacking. The aim of the study is to assess the long-term efficacy and safety of DAA therapy in the CKD population.

METHODS

An observational, cohort single-center study was performed. Fifty-nine CHC subjects with CKD, treated with DAAs between 2016 and 2018, were enrolled in the study. Safety and efficacy profiles were assessed, including sustained virologic response (SVR), occult hepatitis C infection (OCI) incidence, and liver fibrosis.

RESULTS

SVR was achieved in 96% of cases (n = 57). OCI was diagnosed only in one subject following SVR. Significant liver stiffness regression was observed 4 years after SVR compared to baseline values (Mdn = 6.1 kPa, IQR = 3.75 kPa; 4.9 kPa, IQR = 2.9 kPa), < 0.001. The most common adverse events were anemia, weakness, and urinary tract infection.

CONCLUSION

DAAs provide a safe and effective cure for CHC in both CKD patients and KTRs with a favorable safety profile in the long-term follow-up.

摘要

背景

慢性肾脏病（CKD）人群，包括肾移植受者（KTRs）和接受肾脏替代治疗的患者，特别容易因慢性丙型肝炎（CHC）而出现不良后果。目前，有口服直接抗病毒药物（DAAs）可用于根除病毒，短期疗效良好；然而，其长期效果尚缺乏研究。本研究的目的是评估DAAs治疗在CKD人群中的长期疗效和安全性。

方法

进行了一项观察性队列单中心研究。纳入了2016年至2018年间接受DAAs治疗的59例患有CKD的CHC患者。评估了安全性和疗效指标，包括持续病毒学应答（SVR）、隐匿性丙型肝炎感染（OCI）发生率和肝纤维化情况。

结果

96%的病例（n = 57）实现了SVR。仅1例患者在达到SVR后被诊断为OCI。与基线值相比，SVR后4年观察到肝硬度显著下降（中位数 = 6.1 kPa，四分位数间距 = 3.75 kPa；4.9 kPa，四分位数间距 = 2.9 kPa），P < 0.001。最常见的不良事件是贫血、乏力和尿路感染。