1.Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis
Po-Yao HSU ; Yu-Ju WEI ; Jia-Jung LEE ; Sheng-Wen NIU ; Jiun-Chi HUANG ; Cheng-Ting HSU ; Tyng-Yuan JANG ; Ming-Lun YEH ; Ching-I HUANG ; Po-Cheng LIANG ; Yi-Hung LIN ; Ming-Yen HSIEH ; Meng-Hsuan HSIEH ; Szu-Chia CHEN ; Chia-Yen DAI ; Zu-Yau LIN ; Shinn-Cherng CHEN ; Jee-Fu HUANG ; Jer-Ming CHANG ; Shang-Jyh HWANG ; Wan-Long CHUANG ; Chung-Feng HUANG ; Yi-Wen CHIU ; Ming-Lung YU
Clinical and Molecular Hepatology 2021;27(1):186-196
Background/Aims:
Direct‐acting antivirals (DAAs) have been approved for hepatitis C virus (HCV) treatment in patients with end-stage renal disease (ESRD) on hemodialysis. Nevertheless, the complicated comedications and their potential drug-drug interactions (DDIs) with DAAs might limit clinical practice in this special population.
Methods:
The number, class, and characteristics of comedications and their potential DDIs with five DAA regimens were analyzed among HCV-viremic patients from 23 hemodialysis centers in Taiwan.
Results:
Of 2,015 hemodialysis patients screened in 2019, 169 patients seropositive for HCV RNA were enrolled (mean age, 65.6 years; median duration of hemodialysis, 5.8 years). All patients received at least one comedication (median number, 6; mean class number, 3.4). The most common comedication classes were ESRD-associated medications (94.1%), cardiovascular drugs (69.8%) and antidiabetic drugs (43.2%). ESRD-associated medications were excluded from DDI analysis. Sofosbuvir/velpatasvir/voxilaprevir had the highest frequency of potential contraindicated DDIs (red, 5.6%), followed by glecaprevir/pibrentasvir (4.0%), sofosbuvir/ledipasvir (1.3%), sofosbuvir/velpatasvir (1.3%), and elbasvir/grazoprevir (0.3%). For potentially significant DDIs (orange, requiring close monitoring or dose adjustments), sofosbuvir/velpatasvir/voxilaprevir had the highest frequency (19.9%), followed by sofosbuvir/ledipasvir (18.2%), glecaprevir/pibrentasvir (12.6%), sofosbuvir/velpatasvir (12.6%), and elbasvir/grazoprevir (7.3%). Overall, lipid-lowering agents were the most common comedication class with red-category DDIs to all DAA regimens (n=62), followed by cardiovascular agents (n=15), and central nervous system agents (n=10).
Conclusions
HCV-viremic patients on hemodialysis had a very high prevalence of comedications with a broad spectrum, which had varied DDIs with currently available DAA regimens. Elbasvir/grazoprevir had the fewest potential DDIs, and sofosbuvir/velpatasvir/voxilaprevir had the most potential DDIs.
2.Effect of differences in serum creatinine estimation methodologies on estimated glomerular filtration rate.
Su-Chu LEE ; Lee-Moay LIM ; Eddy-Essen CHANG ; Yi-Wen CHIU ; Shang-Jyh HWANG ; Hung-Chun CHEN
Singapore medical journal 2019;60(9):468-473
INTRODUCTION:
Serum creatinine is crucial in glomerular filtration rate (GFR) estimation. Various methods of measuring GFR have been developed, which vary in their ability to estimate the prevalence of chronic kidney disease (CKD) and predict consequences associated with CKD. The use of different laboratory devices also results in uncertainty in estimated GFR (eGFR). The purpose of our study was to discuss the effect of differences in laboratory devices on eGFR when performing serum creatinine measurements.
METHODS:
163 participants aged 51.22 ± 18.66 years were enrolled during a community health screening programme conducted on 18 June 2011. Samples were sent to four different hospitals using four different devices to check serum creatinine by the Jaffe and enzymatic creatinine methods.
RESULTS:
Using Roche Cobas Integra 400, Beckman LX20, Hitachi 7180 and Toshiba TBA - c8000, the proportion of the population with eGFR < 60 mL/min/1.73 m was 11.04%, 6.75%, 20.25% and 20.86%, respectively. Moreover, 3.68% of the participants had eGFR < 60 mL/min/1.73 m in the laboratory when Roche Cobas Integra 400 was used with the enzymatic creatinine method and compensated Jaffe method.
CONCLUSION
Although standardisation of serum creatinine measurement has been achieved by using isotope dilution mass spectrometry, differences in measurement devices still cause substantial bias in the overall results. This affects the application of GFR in the estimation of CKD progression and outcomes associated with CKD.
3.Artificial neural network-based analysis of the safety and efficacy of thrombolysis for ischemic stroke in older adults in Taiwan
Chen-Chih Chung ; You-Chia Chen ; Chien-Tai Hong ; Nai-Fang Chi ; Chaur-Jong Hu ; Han-Hwa Hu ; Lung Chan ; Hung-Wen Chiu
Neurology Asia 2020;25(2):109-117
Background: The risk and benefit of tissue plasminogen activator (tPA) for aged>80 years with acute
ischemic stroke (AIS) are controversial. In this study, we investigated the safety and efficacy of tPA
in this population and utilized the artificial neural network (ANN) to established outcome predictive
models. Methods: We retrospectively reviewed the stroke registry data of patients with AIS, aged >80
years who arrived at the hospital within 3 hours from the onset of symptoms. The characteristics and
the outcomes, presented as modified Rankin Scale (mRS), and mortality rate at 3 months between the
tPA-treated and non-tPA groups were analyzed. An ANN algorithm was applied to establish predictive
models. Results: A total of 80 patients aged>80 years with AIS were identified, and 49 of them received
tPA. After adequate training, our ANN models accurately predicted the outcomes with the area under
the receiver operating characteristic curves of 0.974, and a low error to predict the mRS score at 3
months. After applying our prediction model to those in the non-tPA group, we demonstrated the
potential benefits in those patients if they had undergone tPA therapy.
Conclusions: Our results show that ANN can be a potentially useful tool for predicting the treatment
outcomes of tPA. Such novel machine learning-based models may help with therapeutic decision
making in clinical settings.
4.Metformin and statins reduce hepatocellular carcinoma risk in chronic hepatitis C patients with failed antiviral therapy
Pei-Chien TSAI ; Chung-Feng HUANG ; Ming-Lun YEH ; Meng-Hsuan HSIEH ; Hsing-Tao KUO ; Chao-Hung HUNG ; Kuo-Chih TSENG ; Hsueh-Chou LAI ; Cheng-Yuan PENG ; Jing-Houng WANG ; Jyh-Jou CHEN ; Pei-Lun LEE ; Rong-Nan CHIEN ; Chi-Chieh YANG ; Gin-Ho LO ; Jia-Horng KAO ; Chun-Jen LIU ; Chen-Hua LIU ; Sheng-Lei YAN ; Chun-Yen LIN ; Wei-Wen SU ; Cheng-Hsin CHU ; Chih-Jen CHEN ; Shui-Yi TUNG ; Chi‐Ming TAI ; Chih-Wen LIN ; Ching-Chu LO ; Pin-Nan CHENG ; Yen-Cheng CHIU ; Chia-Chi WANG ; Jin-Shiung CHENG ; Wei-Lun TSAI ; Han-Chieh LIN ; Yi-Hsiang HUANG ; Chi-Yi CHEN ; Jee-Fu HUANG ; Chia-Yen DAI ; Wan-Long CHUNG ; Ming-Jong BAIR ; Ming-Lung YU ;
Clinical and Molecular Hepatology 2024;30(3):468-486
Background/Aims:
Chronic hepatitis C (CHC) patients who failed antiviral therapy are at increased risk for hepatocellular carcinoma (HCC). This study assessed the potential role of metformin and statins, medications for diabetes mellitus (DM) and hyperlipidemia (HLP), in reducing HCC risk among these patients.
Methods:
We included CHC patients from the T-COACH study who failed antiviral therapy. We tracked the onset of HCC 1.5 years post-therapy by linking to Taiwan’s cancer registry data from 2003 to 2019. We accounted for death and liver transplantation as competing risks and employed Gray’s cumulative incidence and Cox subdistribution hazards models to analyze HCC development.
Results:
Out of 2,779 patients, 480 (17.3%) developed HCC post-therapy. DM patients not using metformin had a 51% increased risk of HCC compared to non-DM patients, while HLP patients on statins had a 50% reduced risk compared to those without HLP. The 5-year HCC incidence was significantly higher for metformin non-users (16.5%) versus non-DM patients (11.3%; adjusted sub-distribution hazard ratio [aSHR]=1.51; P=0.007) and metformin users (3.1%; aSHR=1.59; P=0.022). Statin use in HLP patients correlated with a lower HCC risk (3.8%) compared to non-HLP patients (12.5%; aSHR=0.50; P<0.001). Notably, the increased HCC risk associated with non-use of metformin was primarily seen in non-cirrhotic patients, whereas statins decreased HCC risk in both cirrhotic and non-cirrhotic patients.
Conclusions
Metformin and statins may have a chemopreventive effect against HCC in CHC patients who failed antiviral therapy. These results support the need for personalized preventive strategies in managing HCC risk.