Dynamics of creatinine estimated glomerular filtration rate using one or more antiretrovirals that inhibit creatinine tubular secretion
Por:
Elias, MJP, Alejos, B, Gutierrez, MM, Crespo, M, Gil, ID, Ribera, E, Galindo, MJ, Lozano, F, Cifre, AP, Boix, V, Montero-Alonso, M, Sanz, J, Lima, JD, Palacios, R, Moral, SDF, Martinez, E
Publicada:
1 abr 2021
Ahead of Print:
1 ene 2021
Resumen:
Background: Cobicistat, 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.
Methods: Changes 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.
Results: The 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 m(2) 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).
Conclusions: Concomitant use of darunavir/cobicistat plus IPTCrS dolutegravir, rilpivirine, or both produced an additive effect in the expected Cr-eGFR decrease.
Filiaciones:
Elias, MJP:
Hosp Ramon & Cajal, IRYCIS, Madrid, Spain
Alejos, B:
Inst Salud Carlos III Madrid, Madrid, Spain
Gutierrez, MM:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Crespo, M:
Hosp Univ Alvaro Cunqueiro, Vigo, Spain
Gil, ID:
Hosp Univ La Princesa, Madrid, Spain
Ribera, E:
Vall dHebron Res Inst, Barcelona, Spain
Galindo, MJ:
Hosp Clin Valencia, Valencia, Spain
Lozano, F:
Hosp Univ Valme, Seville, Spain
Cifre, AP:
Hosp Son Llatzer, Palma De Mallorca, Spain
Boix, V:
Hosp Gen Univ Alicante, Alicante, Spain
Montero-Alonso, M:
Hosp Univ & Politecn La Fe, Valencia, Spain
Sanz, J:
Hosp Univ Guadalajara, Guadalajara, Spain
Lima, JD:
Hosp Costa Sol, Marbella, Spain
Palacios, R:
Hosp Virgen de la Victoria, IBIMA, Malaga, Spain
Moral, SDF:
Clin Puerta Hierro, Madrid, Spain
Martinez, E:
Hosp Clin Barcelona, Barcelona, Spain
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