Key result
Direct-acting antivirals show no significant effect on QTc interval in chronic hepatitis C.
Why the study?
Direct-acting antivirals are highly effective for chronic HCV infection, but their cardiac safety remains uncertain.
Do direct-acting antivirals affect QTc interval and cardiac function in patients with chronic hepatitis C virus infection?
Cohort (n=100)
No
Do direct-acting antivirals affect QTc interval and cardiac function in patients with chronic hepatitis C virus infection?
Direct-acting antiviral therapy for chronic HCV infection appears to have a good cardiac safety profile with no clinically significant effects on QTc interval or ventricular function.
Answers are grounded in this paper and cite their sources.
DAAs showed no QTc effect in HCV; leaves open confirmation of cardiac safety in randomized trials.
Background Hepatitis C virus (HCV) infection is a major public health problem in Egypt. The use of direct-acting antivirals (DAAs) in such patients has been shown to be highly effective. The cardiac safety of such antivirals remains uncertain. This study aimed to assess the effect of the novel DAAs on corrected QT (QTc) interval and on cardiac function using trans-thoracic echocardiography. Results This was a prospective cohort study performed on 100 patients suffering from chronic HCV infection. Patients were into two equal groups according to the presence of liver cirrhosis. The group without liver cirrhosis received a daily combination of sofosbuvir 400 mg and daclatasvir 60 mg for 12 weeks while that with liver cirrhosis (Child-Pugh score A or B) received a daily combination of sofosbuvir 400 mg, daclatasvir 60 mg, and ribavirin 600 mg for 12 weeks. Surface ECG and trans-thoracic echocardiography were performed prior to the start of treatment and after 12 weeks of treatment. At the end of treatment, no changes were observed in QTc interval in those with ( p = 0.48) or without ( p = 0.048) liver cirrhosis. In patients without liver cirrhosis, right ventricular global longitudinal strain (RV GLS) decreased from 22 (−30 to −17) to −21 (−27–18), p = 0.024. In patients with liver cirrhosis, lateral mitral E’ velocity was reduced from 14.38 ± 3.59 to 13.62 ± 3.21 cm/s, p = 0.02 and indexed left atrial volume (LAVI) was increased from 25.96 ± 3.96 to 26.86 ± 4.12 ml/m 2 , p = 0.032. There were no changes in both groups regarding left ventricular (LV) dimensions, ejection fraction, trans-mitral E/A ratio, E/E’ ratio, deceleration time, right ventricular (RV) systolic pressure, mean pulmonary artery pressure, RV fractional area change, tricuspid annular plane systolic excursion, and LV GLS. Conclusion The current national protocol of HCV infection treatment with direct-acting antiviral agents used in Egyptian patients has a good cardiac safety profile. Such treatments have no effect on QTc interval, left and right ventricular functions except for a decrease in RV GLS in those with no liver cirrhosis and a reduction in lateral mitral E’ velocity in those with liver cirrhosis both remained within the normal reference range.
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Ibrahim et al. (2020) conducted a cohort in Chronic hepatitis C virus infection (n=100). Direct-acting antivirals (sofosbuvir and daclatasvir) vs. Baseline (pre-treatment) was evaluated on Corrected QT (QTc) interval (p=0.48). Treatment with direct-acting antivirals for 12 weeks had no significant effect on the corrected QT interval in chronic hepatitis C patients with or without liver cirrhosis.
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