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D'Ambrosio R, Pasulo L, Puoti M, Vinci M, Schiavini M, Lazzaroni S, Soria A, Gatti F, Menzaghi B, Aghemo A, Capelli F, Rumi MG, Morini L, Giorgini A, Pigozzi MG, Rossini A, Maggiolo F, Pan A, Memoli M, Spinelli O, Del Poggio P, Saladino V, Spinetti A, De Bona A, Capretti A, Uberti-Foppa C, Bonfanti P, Terreni N, Menozzi F, Colombo AE, Giglio O, Centenaro R, Borghi M, Baiguera C, Picciotto V, Landonio S, Gori A, Magnani C, Noventa F, Paolucci S, Lampertico P, Fagiuoli S. Real-world effectiveness and safety of glecaprevir/pibrentasvir in 723 patients with chronic hepatitis C. J Hepatol 2019; 70:379-387. [PMID: 30472321 DOI: 10.1016/j.jhep.2018.11.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [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: 08/08/2018] [Revised: 10/19/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The efficacy and safety of glecaprevir/pibrentasvir (G/P) for patients infected with hepatitis C virus (HCV) have only been investigated in clinical trials, with no real-world data currently available. The aim of our study was to investigate the effectiveness and safety of G/P in a real-world setting. METHODS All patients with HCV consecutively starting G/P between October 2017 and January 2018 within the NAVIGATORE-Lombardia Network were analyzed. G/P was administered according to drug label (8, 12 or 16 weeks). Fibrosis was staged either histologically or by liver stiffness measurement. Sustained virological response (SVR) was defined as undetectable HCV-RNA 12 weeks after the end of treatment. RESULTS A total of 723 patients (50% males) were treated with G/P, 89% for 8 weeks. The median age of our cohort was 58 years, with a median body mass index of 23.9 kg/m2, and median liver stiffness measurement of 6.1 kPa; 84% were F0-2 and 16% were interferon-experienced. Median HCV-RNA was 1,102,600 IU/ml, and 49% of patients had HCV genotype 1 (32% 1b), 28% genotype 2, 10% genotype 3 and 13% genotype 4. The median estimated glomerular filtration rate was 90.2 ml/min, platelet count 209x103/mm3 and albumin 4.3 g/dl. The SVR rates were 94% in intention-to-treat and 99.3% in per protocol analysis (8-week vs. 12 or 16-week: 99.2% vs. 100%). Five patients failed therapy because of post-treatment relapse; a post-treatment NS5A resistance-associated substitution was detected in 1 case. SVR rates were lower in males (p = 0.002) and in HCV genotype-3 (p = 0.046) patients treated for 8 weeks, but independent of treatment duration, fibrosis stage, baseline HCV-RNA, HIV co-infection, chronic kidney disease stage and viral kinetics. Mild adverse events were reported in 8.3% of the patients, and 0.7% of them prematurely withdrew treatment. Three patients died of drug-unrelated causes. CONCLUSIONS In a large real-world cohort of Italian patients, we confirmed the excellent effectiveness and safety of G/P administered for 8, 12 or 16 weeks. LAY SUMMARY A large number of patients with hepatitis C virus have been treated with glecaprevir/pibrentasvir (G/P) within the NAVIGATORE-Lombardia Network, in Italy. This is the first real-world study evaluating effectiveness and safety of G/P in patients with hepatitis C virus treated according to international recommendations. This study demonstrated excellent effectiveness (with sustained virological response rates of 99.3%) and safety profiles.
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Affiliation(s)
- Roberta D'Ambrosio
- CRC A.M. e A. Migliavacca Center for Liver Diseases, Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
| | - Luisa Pasulo
- Bergamo HCV Network, ASST Papa Giovanni XXIII, Italy
| | - Massimo Puoti
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Vinci
- Gastroenterology and Hepatology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | - Alessandro Soria
- Infectious Diseases, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Federico Gatti
- Hospital Pharmacy, ASST Ovest Milanese, Legnano (MI), Italy
| | - Barbara Menzaghi
- Infectious Diseases, Busto Arsizio Hospital, ASST Valle Olona, Varese, Italy
| | - Alessio Aghemo
- Internal Medicine and Hepatology, Humanitas Research Hospital and Humanitas University, Pieve Emanuele (MI), Italy
| | | | - Maria Grazia Rumi
- Hepatology, San Giuseppe Hospital, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Morini
- Internal Medicine, ASST Ovest Milanese, Abbiategrasso (MI), Italy
| | | | | | | | | | - Angelo Pan
- Infectious Diseases, ASST Cremona, Cremona (MI), Italy
| | | | | | | | | | | | | | | | - Caterina Uberti-Foppa
- Immunology and Infectious Diseases, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | | | - Riccardo Centenaro
- Internal Medicine, Vizzolo Predabissi Hospital, Vizzolo Predabissi (MI), Italy
| | - Marta Borghi
- CRC A.M. e A. Migliavacca Center for Liver Diseases, Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Chiara Baiguera
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Viviana Picciotto
- Gastroenterology and Hepatology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Andrea Gori
- Infectious Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Carlo Magnani
- Infectious Diseases, ASST Ovest Milanese, Legnano (MI), Italy
| | | | - Stefania Paolucci
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Pietro Lampertico
- CRC A.M. e A. Migliavacca Center for Liver Diseases, Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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Mottola L, Cenderello G, Piazzolla VA, Forte P, Carretta V, Mecenate F, Brancaccio G, Minisini R, Zuin M, Terreni N, Monti M, Colombo AE, Nosotti L, Minerva N, Luzzitelli I, Kostandini A, Cuccorese G, Russello M, Santoro R, Mangia A. Interleukin-28B genetic variants in untreated Italian HCV-infected patients: a multicentre study. Liver Int 2015; 35:482-8. [PMID: 25039676 DOI: 10.1111/liv.12630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/26/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS Different prevalence of favourable IL28BCC genotype have been reported in studies performed in different countries around the world. Data on distribution of IL28B genotypes in healthy Italian subjects are lacking. METHODS Studies on prospectively collected untreated chronic HCV-infected Italian patients led to conflicting results. To investigate the prevalence of IL28B genotypes in untreated HCV-infected patients and in subjects able to clear HCV, and to compare them to the prevalence registered in healthy Italian controls. To evaluate IL28B prevalence across different HCV genotypes. RESULTS IL28BCC was observed in 30.9% of chronic HCV patients, in 71.0% of subjects able to clear HCV infection and in 41.6% of the Italian controls. The frequency of IL28BCC was higher in HCV genotype 2 and 3 than in 1 (38.3 vs. 28.2) (P = 0.02). Levels of ALT higher in IL28BCC than in non-CC were observed regardless of HCV genotypes (P = 0.0014). CONCLUSIONS IL28BCC frequencies progressively decline from subjects with spontaneous HCV clearance to normal non-infected subjects and to chronically infected. This study suggests that patients with IL28BCC, if genotype 1, are able to clear HCV more often than if genotype 2 and 3 infected, and that CC genotype is associated with higher grade of necro-inflammation.
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Affiliation(s)
- Leonardo Mottola
- Liver Unit, Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy
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Vitolo E, Madoi S, Palvarini M, Sponzilli C, De Maria R, Ciró E, Colombo AE, Vallino F, Saruggia M. Relationship between changes in R wave voltage and cardiac volumes. A vectorcardiographic study during hemodialysis. J Electrocardiol 1987; 20:138-46. [PMID: 3598455 DOI: 10.1016/s0022-0736(87)80103-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The effects of acute changes in cardiac volumes determined by hemodialysis on cardiac voltages were assessed in 18 chronically uremic patients by means of a vectorcardiographic and scalar Frank leads recording, immediately before, at the 90th and 180th minute, and immediately after hemodialysis. The following parameters were simultaneously monitored: body weight, systolic and diastolic blood pressure, heart rate, hematocrit and, in eight patients, echocardiographic systolic and diastolic diameters of the left ventricle. During hemodialysis all voltages considered except R wave in X lead increased significantly. They were inversely correlated with body weight, blood pressure, and systolic and diastolic diameters and directly with hematocrit (volemia-dependent parameters). The maximal vector on the left sagittal plane and the R wave amplitude in Z lead, representing left ventricular posterolateral wall activation, showed the greatest increase. When, at the end of hemodialysis, an amount of fluids ranging from 300 to 800 ml was restored, these cardiac voltages decreased paralleling the increase of left ventricular diameters. In conclusion, these results demonstrate that cardiac voltage and volumes are inversely related.
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