The efficacy and tolerability of glecaprevir/pibrentasvir treatment in a real-world chronic hepatitis C patients cohort

Background and Aim

The aims of the present study were to evaluate the real-life efficacy and tolerability of glecaprevir (GLE)/pibrentasvir (PIB) in the treatment of patients with chronic hepatitis C (CHC).

Materials and Methods

Between May 2019 and May 2022, 686 patients with CHC, treated with GLE/PIB combination from 21 participating centers in Turkiye, were enrolled in the study.

Results

All patients were Caucasian, and their median age was 56 years. At the start of GLE/PIB treatment, the median serum Hepatitis C virus RNA and serum alanine amino transaminase (ALT) levels were 6.74 log10 IU/mL and 47 U/L, respectively. Fifty-three percent of the patients were infected with genotype 1b, followed by genotype 3 (17%). Diabetes was the more common concomitant disease. The sustained virological response (SVR12) was 91.4% with intent-to-treat analysis and 98.5% with per protocol analysis. The SVR12 rates were statistically significant differences between the patients who were i.v. drug users and non-user (88.0% vs. 98.8%, p=0.025). From the baseline to SVR12, the serum ALT levels and Model for End-Stage Liver Disease score were significantly improved (p<0.001 and p=0.014, respectively). No severe adverse effect was observed.

Conclusion

GLE/PIB is an effective and tolerable treatment in patients with CHC.

TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease and is significantly associated with obesity, insulin resistance, type 2 diabetes mellitus, metabolic syndrome, and cardiovascular disease. NAFLD has become the most prevalent chronic liver disease in Western countries, and the proportion of NAFLD-related cirrhosis among patients on liver transplantation waiting lists has increased. In light of the accumulated data about NAFLD, and to provide a common approach with multi-disciplines dealing with the subject, it has become necessary to create new guidance for diagnosing and treating NAFLD. This guidance was prepared following an interdisciplinary study under the leadership of the Turkish Association for the Study of the Liver (TASL), Fatty Liver Special Interest Group. This new TASL Guidance is a practical application guide on NAFLD and was prepared to standardize the clinical approach to diagnosing and treating NAFLD patients. This guidance reflects many advances in the field of NAFLD. The proposals in this guidance are meant to aid decision-making in clinical practice. The guidance is primarily intended for gastroenterology, endocrinology, metabolism diseases, cardiology, internal medicine, pediatric specialists, and family medicine specialists.

Hepatitis B Virus Screening and Real Life Data in Patients with Solid Tumor Receiving Chemotherapy

BACKGROUND

Reactivation of the hepatitis B virus (HBV) either during or after chemotherapy may cause serious and sometimes fatal hepatitis. All patients undergoing chemotherapy should therefore be screened in terms of HBV before chemotherapy. The purpose of this research was to identify HBV screening rates in patients with solid cancer undergoing parenteral chemotherapy and to determine the outcomes of patients undergoing HBV screening.

METHODS

Data for patients undergoing parenteral chemotherapy for solid cancer from January 1, 2012 to December 30, 2018 were retrieved from our electronic health record patient files in this retrospective study. Screening was defined as hepatitis B surface antigen (HBsAg) and/or hepatitis B core antibody (HBcAb) tests carried out within six months prior the first chemotherapy session.

RESULTS

Four thousand fifty-eight (63%) of the 6440 patients who underwent parenteral chemotherapy were screened for HBsAg and/or HBcAb. The proportions of patients screened for HBsAg and HBcAb improved from 38.8% (2012) to 76.3% (2018), and from 0.2% (2012) to 43% (2018), respectively (P<0.001). The HBsAg and HBcAb positivity rates were 2.9% and 36.5%, respectively. Antiviral prophylaxis was started in 11.8% of HBsAg-negative/HBcAb-positive patients and 40.5% of HBsAg-positive patients. HBV reactivation did not occur in patients receiving antiviral prophylaxis, but was identified in 7.2% of HBsAg-positive patients and 0.6% of HBsAg-negative/HBcAb-positive patients without antiviral prophylaxis.

CONCLUSION

Although HBV screening rates before chemotherapy are increasing among solid cancer patients, the rate of initiation of antiviral prophylaxis is still low. It is therefore important to raise awareness regarding HBV reactivation during/after chemotherapy.

Hepatitis B Reactivation in HBsAg-negative Anti-HBc-positive patients receiving cytotoxic chemotherapy for solid tumors

PURPOSE

The prevalence of hepatitis B virus (HBV) reacti- vation in HBsAg-negative/anti-HBc-positive patients receiving chemotherapy for solid tumors is not fully known. The aim of this study was to investigate the incidence and outcomes of HBV reactivation in these patients.

METHODS

Data among 645 HBsAg-negative/ anti-HBc-positive patients who underwent intravenous chemotherapy were retrospectively analyzed. Patients were categorized into two groups, based on received antiviral prophylaxis (n = 43) or not (n = 602). HBV reactivation was defined as the presence of detectable serum HBV DNA or HBsAg seroconversion from negative to positive, with or without increased liver enzymes.

RESULTS

HBV reactivation was detected in 3 patients (0.49%) among non-antiviral prophylaxis group and in none of those with antiviral prophylaxis. Two of the HBV reactivation detected patients were successfully treated with rescue therapy, while the third died due to liver failure.

CONCLUSIONS

HBV reactivation is rare in HBsAg-negative and anti-HBc-positive patients receiving chemotherapy for solid tumors. However, considering the fatal outcomes patients must be closely monitored in terms of HBV-DNA positivity and/or HBsAg seroreversion and pre-emptive antiviral therapy must be initiated as soon as HBV reactivation occurs.

Higher Thrombin-Antithrombin III Complex Levels May Indicate Severe Acute Pancreatitis

AIM

Coagulation disorders may develop in association with severe acute pancreatitis (AP). Plasma thrombin-antithrombin III complex (TAT) levels are one of the principal markers of coagulation disorder. The purpose of this study was to evaluate TAT and other hemostatic parameters in patients with AP and to examine whether or not these parameters indicate the severity of AP.

METHOD

Forty-six patients with AP (14 severe, 32 non-severe) and a 30-member healthy control group were recruited. The severity of AP was determined using the revised Atlanta classification. ELISA was used to measure patients' plasma TAT levels.

RESULTS

The TAT levels of AP patients at presentation were higher than those of the control group (p = 0.005). The plasma TAT levels of patients with severe AP were also significantly higher than those of patients with non-severe AP (p = 0.05) and of the control group (p < 0.001). The general accuracy, sensitivity and specificity of TAT levels in predicting the severity of AP were 77.4, 77.8, and 77.3% respectively.

CONCLUSION

The coagulation cascade was activated in the AP patients in our study, and this was shown to become more pronounced as severity of the disease increased. Plasma TAT levels at the time of presentation in patients with AP can be used as a marker for predicting the severity of the disease.

Plasma viscosity: a potential predictor of both medical treatment response and clinical stage of ulcerative colitis

AIM

Ulcerative colitis (UC) is one of the major forms of chronic relapsing inflammatory bowel diseases. The ability to identify type, severity and responsiveness to therapy of UC using laboratory parameters has long been the aim of clinical studies. The aim of this study was to assess the relation betweenplasma viscosity (PV) and disease activity and response to medical treatment in patients with UC.

MATERIAL AND METHODS

The study included 105 patients with UC and 42 healthy volunteers. Blood samples were assessed for PV, erythrocyte sedimentation rate (ESR), high sensitive C-reactive protein (hs-CRP), D-dimer, and fibrinogen.

RESULTS

Patients with UC were grouped according to disease activity, i.e. active (n= 59) and remission (n= 46). PV was higher in those with active UC compared with those with UC in remission or healthy subjects. It was significantly higher in both UC refractory to steroid compared to UC responsive to steroid (p< 0.001) and UC refractory to cyclosporine compared to UC responsive cyclosporine (p= 0.003). IncreasedSimple Clinical Colitis Activity Index (SCCAI), Endoscopic Grading Scale (EGS), and Histological Disease Activity (HAD) scores were significantly associated with higher PV in patients with UC.

CONCLUSION

PV is a useful marker in predicting response to steroid or cyclosporine treatment in patients with active UC. It could be replaced by ESR or hs-CRP as a measure of the acute phase response in UC since it is sufficiently sensitive. These findings may help identify patients with active UC who will require colectomy.

KEY WORDS

Biomarkers, Disease activity, Medical treatment, Steroid-refractory ulcerative colitis, Ulcerative colitis.

Differences in nephrotoxicity risk and renal effects among anti-viral therapies against hepatitis B

BACKGROUND

Results are conflicting with respect to the renal effects of anti-viral agents used for hepatitis B virus infection.

AIM

To compare short and long-term renal effects in real-life settings and to determine risk factors for renal impairment during treatment.

METHODS

2221 treatment-naïve patients were enrolled. Among these, 895 (302 lamivudine, 27 telbivudine, 282 entecavir, 273 tenofovir and 11 adefovir initiated patients) had 'repeated measures' of creatinine (baseline, 1st, 6th, 12th and 24th month of treatment). Telbivudine and adefovir groups were excluded from further analysis because of the low number of patients. We calculated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) formula at each time point. Hypophosphataemia was also recorded. Risk factors for renal impairment were analysed.

RESULTS

Tenofovir caused a decline in GFR at each time point when compared to baseline levels. However, lamivudine and entecavir did not change GFR. GFR-shifting from ≥90 to 60-89 mL/min/1.73 m(2) was comparable among groups. The proportion of patients whose baseline creatinine increased more than 25% was comparable among all anti-virals. GFR showed a decline in patients who switched from entecavir to tenofovir. One patient with compensated cirrhosis needed to change from tenofovir because of renal safety. Seven and three patients developed transient hypophosphataemia in the tenofovir and lamivudine groups, respectively.

CONCLUSIONS

Although tenofovir caused a decline in GFR, differences between the anti-viral agents do not appear to be so impressive. In patients with and without renal risk factors at baseline, there is no impact of anti-virals, including tenofovir.

Low eradication rate of Helicobacter pylori with triple 7-14 days and quadriple therapy in Turkey

AIM: The eradication rate of Helicobacter pylori (H pylori) shows variation among countries and regimens of treatment. We aimed to study the eradication rates of different regimens in our region and some factors affecting the rate of eradication.

METHODS: One hundred and sixty-four H pylori positive patients (68 males, 96 females; mean age: 48 ± 12 years) with duodenal or gastric ulcer without a smoking history were included in the study. The patients were divided into three groups according to the treatment regimens. Omeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1 g were given twice daily for 1 week (Group I) and 2 weeks (Group II). Patients in Group III received bismuth subsitrate 300 mg, tetracyline 500 mg and metronidazole 500 mg four times daily in addition to Omeprazole 20 mg twice daily. Two biopsies each before and after treatment were obtained from antrum and corpus, and histopathologically evaluated. Eradication was assumed to be successful if no H pylorus was detected from four biopsy specimens taken after treatment. The effects of factors like age, sex, H pylori density on antrum and corpus before treatment, the total H pylori density, and the inflammation scores on the rate of H pylori eradication were evaluated.

RESULTS: The overall eradication rate was 42%. The rates in groups II and III were statistically higher than that in group I (P < 0.05). The rates of eradication were 24.5%, 40.7% and 61.5% in groups I, II and III, respectively. The eradication rate was negatively related to either corpus H pylori density or total H pylori density (P < 0.05). The median age was older in the group in which the eradication failed in comparison to that with successful eradication (55 yr vs 39 yr, P < 0.001). No correlation between sex and H pylori eradication was found.

CONCLUSION: Our rates of eradication were significantly lower when compared to those reported in literature. We believe that advanced age and high H pylori density are negative predictive factors for the rate of H pylori eradication.