eGFR Evolution in HCV Patients Receiving SOF-based or SOF-free DAAs
eGFR Evolution in HCV Patients Receiving SOF-based or SOF-free DAAs
Data regarding the nephrotoxicity of sofosbuvir (SOF) remain controversial. The investigators
 compared the changes of estimated glomerular filtration rate (eGFR) in patients with chronic
 hepatitis C virus (HCV) infection receiving SOF-based or SOF-free direct acting antivirals
 (DAAs).
Chronic hepatitis C virus (HCV) infection is a major health problem that affects 71 million
 people worldwide. Patients with chronic HCV infection may present with various hepatic and
 extrahepatic manifestations which lead to substantial morbidity and mortality. In contrast,
 the long-term health outcome improves following successful HCV eradication by antiviral
 therapies.

 Owing to the excellent efficacy and safety as well as the short treatment duration, the use
 of interferon (IFN)-free direct acting antivirals (DAAs) has become the standard-of-care for
 managing HCV. Sofosbuvir (SOF) is a pyrimidine nucleotide analogue which acts as the HCV
 ribonucleic acid (RNA) chain terminator by inhibiting HCV non-structural protein 5B (NS5B)
 RNA-dependent RNA polymerase following intrahepatic activation to uridine triphosphate form.
 Dephosphorylation results in the formation of inactive metabolite (GS-331007) that undergoes
 extensive renal excretion. Clinically, SOF is administered once-daily with pangenotypic
 potency, well tolerability and a high genetic barrier to drug resistance. Furthermore, SOF
 can be used in combination with NS3/4A protease inhibitors (PIs), NS5A inhibitors, and/or
 ribavirin (RBV) to achieve high rates of sustained virologic response (SVR). Therefore,
 applying SOF-based DAAs for HCV is welcome to most treating physicians.

 Following the widespread use of SOF-based DAAs for treating HCV in different populations, a
 large-scale real-world HCV-TARGET study enrolling 1,789 patients indicated that patients with
 a baseline eGFR ≤ 45 mL/min/1.73m2 were associated with a higher risk of worsening renal
 function than those with a baseline eGFR > 45 mL/min/1.73m2 following SOF-based DAAs.
 Moreover, three retrospective studies showed that SOF-based DAAs negatively affected the
 on-treatment and off-therapy eGFR. On the contrary, other studies showed that the use of
 SOF-based DAAs did not worsen the eGFR. Because most studies were retrospective in nature
 without protocol-defined time point for eGFR assessment or patient election, and did not
 enroll patients receiving SOF-free DAAs as the controls, the investigators thus conducted a
 prospective study to evaluate the evolution of eGFR in patients with chronic HCV infection
 receiving SOF-based or SOF-free DAAs.
Inclusion Criteria:

 -  Chronic HCV patients receiving SOF-based or SOF-free DAAs for 12 weeks

 Exclusion Criteria:

 -  Decompensated cirrhosis (Child-Pugh B or C)

 -  Estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73m2

 -  Active hepatocellular carcinoma (HCC)

 -  Organ transplantation

 -  Hepatitis B virus (HBV) co-infection

 -  Human immunodeficiency virus (HIV) co-infection

 -  Not received off-therapy follow-up till week 24