ABSTRACT
Background and Aims: The treatment of chronic hepatitis C (CHC) has evolved from genotype-specific to pan-genotypic direct acting antivirals (DAAs) with high efficacy and safety. However, drug-drug interactions (DDIs) must be avoided when used in combination with other medications, especially with the possible concomitant use of COVID-19 infection antivirals during the COVID-19 pandemic. This study aimed to access the potential DDIs of concomitant drugs with pan-genotypic DAAs and COVID-19 infection antivirals, and actual incidence of DDIs in real-world experience. Method(s): From January 2022 to October 2022, consecutive 116 HCV patients receiving pan-genotypic DAAs were retrospectively enrolled in Taipei Veterans General Hospital. The number of comedications and their potential DDIs with three pan-genotypic DAA regimens and three COVID-19 infection antivirals were analyzed. The actual incidence of DDIs during DAAs treatment were also investigated. Result(s): The mean age was 60.9 years old, with male predominant (55.2%). Of them, 12 (10.3%) patients had cirrhosis, and 24 (20.7%) patients had diabetes mellitus. Most patients were within Child-Pugh class A (109/116, 94.0%). The distribution of HCV genotypes was 8.6% in GT 1a, 36.2% in GT 1b, 39.7% in GT 2, 6.9% in GT 6, and 8.6% in indeterminate genotype, respectively. Of them, 43 (37.1%) patients received GLE/PIB, 69 (59.5%) received SOF/VEL 7plusmn;RBV, and 4 (3.4%) received SOF/VEL/VOX as DAAs regimen. Noteworthy, four patients had COVID-19 infection during DAAs treatment course. The rates of ETVR and SVR12 were 97.6% and 95.3%. The mean number of concomitant medications was 2.01. The distribution of concomitant drugs was 64.7% with no concomitant drug, 11.2% with 1-3 drugs, 11.2% with 4-6 drugs, 9.5% with 7-9 drugs, and 3.4% had more than 9 drugs, respectively. In potential contraindicated (red) DDI class, GLE/PIB was the most prevalent (7.3%), followed by SOF/VEL/VOX (6.4%), and SOF/VEL (1.8%) for non-cirrhosis and compensated cirrhosis patients;and no red DDI occurred in decompensated cirrhosis patients. In addition, the percentage of patients without potential DDIs was higher with SOF/VEL (79.8%) than with the other regimens. The potential red DDIs were predominantly with lipid-lowering agents for DAAs. For potential red DDI class with COVID-19 infection antivirals, Nirmatrelvir/Ritonavir was the most prevalent (6%), followed by Remdesivir (0.9%), and no potential DDIs with Molnupiravir. For COVID-19 antivirals, the potential red DDIs was mainly with central nervous system drugs. Finally, the actual incidence of DDIs during DAAs treatment showed no red DDI occurred for all patients, and GLE/PIB was the most prevalent (93%) of no potential DDIs. Conclusion(s): The potential DDIs between these comedications differed, with the most potential DDIs occurring with GLE/PIB and Nirmatrelvir/Ritonavir. After careful assessment of comedications and their potential DDIs, the actual incidence of DDIs could be reduced, and optimize safety in real-world practice.
ABSTRACT
In order to evaluate the effect of air pollutions emission reduction in Beijing, Tianjin, Hebei and its surrounding 26 cities ("2 + 26" cities) from January to March in 2020 during the epidemic of COVID-19, the air quality model of nested air quality prediction modeling system (NAQPMS) was applied to conduct a few scenarios. The characteristics of air quality from January to March 2020, and during the periods before and after the epidemic of COVID-19 were investigated. The influences of meteorology, emergency emission reduction measures and social economic activities on ambient air quality as well as the uncertainties were elucidated and discussed. The results showed that the number of days achieving good and moderate air quality standard in "2+26" cities accounted for 59.6%, on average of 10.9% increase relative to the same period last year. The mean concentration of PM10, PM2.5, SO2, NO2, O3-8h-90 per and CO-95 per in "2 + 26" cities from January to March in 2020 were 108, 76, 14, 109, 36μg/m3, and 2.3mg/m3, respectively. During the epidemic period from January 24 to March 31, the concentrations of PM10, NO2, PM2.5, and CO decreased significantly compared with the period prior to the epidemic from January 1to 23. In contrast to January to March in 2019, the PM2.5 concentrations of the cities along the Yan mountain and Taihang mountain increased by 1%~8% in 2020. However, the model simulations revealed that the emergency emission reduction measures potentially avoided twice of the regional heavy air pollution events, resulting in the quarterly mean PM2.5 concentration in "2 + 26" cities reduced by 6 to 26μg/m3. Due to the influence of the Spring Festival holiday and epidemic, the traffic emissions were reduced substantially. In contrast, the emissions from the industry such as coking and thermal power did not show large variations, and the negative impact of loose coal combustion on ambient air quality may become even more severe. © 2021, Editorial Board of China Environmental Science. All right reserved.