Dynamics of creatinine estimated glomerular filtration rate using one or more antiretrovirals that inhibit creatinine tubular secretion
| Autor: | Maria Jesus, Perez Elias, Belen, Alejos, Maria Mar, Gutierrez, Manuel, Crespo, Ignacio, De Los Santos Gil, Esteve, Ribera, Maria Jose, Galindo, Fernando, Lozano, Antonio, Payeras Cifre, Vicente, Boix, Marta, Montero-Alonso, José, Sanz, Javier, De La Torre Lima, Rosario, Palacios, Sara, De La Fuente Moral, Esteban, Martinez, María, Yllescas |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty Anti-HIV Agents Urology Renal function HIV Infections 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine medicine Humans Pharmacology (medical) 030212 general & internal medicine Darunavir Retrospective Studies Pharmacology Creatinine business.industry Cobicistat 030112 virology Infectious Diseases chemistry Concomitant Rilpivirine Dolutegravir business Tubular secretion Glomerular Filtration Rate medicine.drug |
| Zdroj: | Journal of Antimicrobial Chemotherapy. 76:1046-1050 |
| ISSN: | 1460-2091 0305-7453 |
| DOI: | 10.1093/jac/dkaa547 |
| Popis: | BackgroundCobicistat, dolutegravir and rilpivirine are all modest inhibitors of proximal tubular creatinine secretion (IPTCrS) and hence a moderate and early non-progressive creatinine estimated glomerular filtration rate (Cr-eGFR) reduction has been observed in clinical trials. Data regarding the impact of combination of those drugs on Cr-eGFR, in the clinical practice, are scarcely known.MethodsChanges in Cr-eGFR after starting darunavir/cobicistat alone or in combination with dolutegravir and/or rilpivirine were studied in a nationwide retrospective cohort study of consecutive HIV-infected patients initiating darunavir/cobicistat. The relationship between Cr-eGFR changes over time and the use of darunavir/cobicistat alone or darunavir/cobicistat plus dolutegravir and/or rilpivirine adjusted by different HIV patient’s characteristics, socio-demographics, HIV severity and use of tenofovir concomitant medication other than antiretrovirals was explored through univariate and multivariate analyses.ResultsThe analysis included 725 patients. At 48 weeks, the combination of two or more IPTCrS (darunavir/cobicistat with rilpivirine and/or dolutegravir) was associated with higher decreases in Cr-eGFR [adjusted median difference (±SD) –3.5 ± 1.6 (95% CI –6.6 to –0.3), P = 0.047], and a decrease up to or higher than 15 mL/min/1.73 m2 was more frequent [adjusted OR 3.233 (95% CI 1.343–7.782), P = 0.009], with respect to darunavir/cobicistat alone. The Cr-eGFR changes between darunavir/cobicistat and darunavir/cobicistat with rilpivirine and/or dolutegravir showed more significant decreases in patients taking two or more IPTCrS at 12, 24 and 48 weeks. (ClinicalTrials.gov: NCT03042390).ConclusionsConcomitant use of darunavir/cobicistat plus IPTCrS dolutegravir, rilpivirine, or both produced an additive effect in the expected Cr-eGFR decrease. |
| Databáze: | OpenAIRE |
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