RESUMEN
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.
RESUMEN
Objectives: Worldwide, the COVID-19 pandemic has resulted in lifestyle disruptions, with lockdowns and curtailed activities. This was acutely felt in Asia from February 2020 onwards. Such drastic changes in lifestyle habits may impact negatively on metabolic related diseases. We explored these changes and their effects in patients with metabolic associated fatty liver disease (MAFLD). Materials and Methods: The data of MAFLD patients who were prospectively enrolled from eleven Asian centres in a longitudinal cohort study were analyzed. The data from 1st January 2019 (pre- COVID-19), were compared with the data from 1st February 2020 onwards (during COVID-19). Patients were stratified by physical activity level and whether they met target recommendation of[ 150 min of moderate/vigorous exercise per week. Results: A total of 229 patients were evaluated. Mean age was 59 ± 9.6 years with 136 (59.4%) males. During the COVID-19 pandemic, 50 (21.8%) patients maintained moderate/vigorous exercise, while 28 (12.2%) and 33 (14.4%) patients started and stopped moderate/vigorous exercising respectively. 118 patients (51.5%) did not participate in moderate/vigorous exercise either before or during the pandemic. Seventy-eight (34.1%) patients achieved[150 min moderate/vigorous exercise per week at the last visit. With the onset of COVID-19, reduction of physical activity of any kind was demonstrated in the majority (65.9%) of patients. There was a reduction of any physical activity including walking amongst those who stopped moderate/vigorous exercise and those without moderate/ vigorous exercise throughout. No significant changes in BMI, waist or hip circumference were observed in any activity level group. In patients who stopped moderate/vigorous exercise, alanine transaminase and aspartate transaminase significantly increased by 18.5% and 14.8% respectively. Conclusion: Stoppage of moderate/vigorous exercise leads to worsening of liver enzymes in patients with MAFLD and may have deleterious effects long term. As we adapt to live with COVID endemicity, novel modified healthy lifestyle habits would be needed to manage MAFLD.