We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Dynamics of creatinine estimated glomerular filtration rate using one or more antiretrovirals that inhibit creatinine tubular secretion.
- Authors
Elias, Maria Jesus Perez; Alejos, Belen; Gutierrez, Maria Mar; Crespo, Manuel; Gil, Ignacio De Los Santos; Ribera, Esteve; Galindo, Maria Jose; Lozano, Fernando; Cifre, Antonio Payeras; Boix, Vicente; Montero-Alonso, Marta; Sanz, José; Lima, Javier De La Torre; Palacios, Rosario; Moral, Sara De La Fuente; Martinez, Esteban; Group, the Codar Study; Perez Elias, Maria Jesus; De Los Santos Gil, Ignacio; Payeras Cifre, Antonio
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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 m2 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).<bold>Conclusions: </bold>Concomitant use of darunavir/cobicistat plus IPTCrS dolutegravir, rilpivirine, or both produced an additive effect in the expected Cr-eGFR decrease.
- Subjects
GLOMERULAR filtration rate; ANTIRETROVIRAL agents; CREATININE; RITONAVIR; ATAZANAVIR; SECRETION; DARUNAVIR
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2021, Vol 76, Issue 4, p1046
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dkaa547