Short and long-term effects of telaprevir on kidney function in patients with hepatitis C virus infection: a retrospective cohort study.
BACKGROUND
Recent reports suggest that telaprevir, a protease inhibitor used to treat hepatitis C infection, is associated with decline in kidney function during therapy, particularly in patients with baseline renal impairment.


METHODS
Patients treated with telaprevir in a single healthcare network were retrospectively reviewed. Kidney function was determined at baseline, during therapy, and twelve weeks and twelve months after telaprevir discontinuation. Significant creatinine rise during therapy was defined as an increase in serum creatinine ≥ 0.3mg/dL from baseline during treatment with telaprevir.


RESULTS
Between July 2011 to January 2013,seventy-eight patients began treatment. The majority completed the prescribed twelve weeks of telaprevir therapy; 32% discontinued due to side effects. The average rise in serum creatinine during therapy was 0.22mg/dL (standard deviation 0.22mg/dL). Thirty-one percent experienced a significant creatinine rise during therapy. Decline in estimated glomerular filtration rate (eGFR) was lower in those with baseline eGFR < 90 mL/min/1.73m2 compared to the group with baseline eGFR ≥ 90 mL/min/1.73m2 (12 vs. 18 mL/min/1.73m2, P = 0.047). Serum creatinine fully normalized by twelve weeks after cessation of telaprevir in 83% of patients, however experiencing a significant creatinine rise during telaprevir use was associated with a 6.6mL/min/1.73m2 decrease in estimated glomerular filtration rate at twelve months in an adjusted model.


CONCLUSIONS
Decline in kidney function during therapy with telaprevir is common and is not associated with baseline eGFR < 90mL/min/1.73m2 as previously reported.
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, MA, United States of America.
Meghan E
ME
Sise
Department of Pharmacy, Massachusetts General Hospital, Harvard University, Boston, MA, United States of America.
Elke S
ES
Backman
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, MA, United States of America.
Julia B
JB
Wenger
Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States of America.
Brian R
BR
Wood
Division of Infectious Diseases, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States of America.
Paul E
PE
Sax
Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, MA, United States of America.
Raymond T
RT
Chung
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, MA, United States of America.
Ravi
R
Thadhani
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard University, Boston, MA, United States of America.
Arthur Y
AY
Kim
D000328:Adult; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009842:Oligopeptides / Q000009:adverse effects / Q000627:therapeutic use*; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies
D009842:Oligopeptides; D011480:Protease Inhibitors; C486464:telaprevir; D003404:Creatinine