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"descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bacterial composition of the gut microbiota by genus and phylum or class, obtained by next-generation sequencing of DNA extracted from the stool samples of Spanish and Danish subjects of the MetaHIT cohort (data published by Arumugam et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Julia Álvarez, José Manuel Fernández Real, Francisco Guarner, Miguel Gueimonde, Juan Miguel Rodríguez, Miguel Saenz de Pipaon, Yolanda Sanz" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Julia" "apellidos" => "Álvarez" ] 1 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Fernández Real" ] 2 => array:2 [ "nombre" => "Francisco" "apellidos" => "Guarner" ] 3 => array:2 [ "nombre" => "Miguel" "apellidos" => "Gueimonde" ] 4 => array:2 [ "nombre" => "Juan Miguel" "apellidos" => 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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "536" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Concepció Bartres, Guillem Soy, Xavier Forns" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Concepció" "apellidos" => "Bartres" ] 1 => array:2 [ "nombre" => "Guillem" "apellidos" => "Soy" ] 2 => array:4 [ "nombre" => "Xavier" "apellidos" => "Forns" "email" => array:1 [ 0 => "xforns@clinic.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de la hepatitis C en pacientes con anticonvulsivos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Treatment of chronic hepatitis C in patients who are undergoing anticonvulsant treatment may be challenging. Drugs that are potent P-glycoprotein (P-gp) and cytochrome P450 (CYP) inducers (e.g. carbamazepine, phenobarbital, phenytoin) are contraindicated with direct acting antivirals (DAA) because of the decrease in exposure, with a potential loss in efficacy.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Temporal interruption of anticonvulsant therapy, or even changes in the treatment regimen are usually very difficult, if not impossible.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 55 year old female with a diagnosis of epilepsy (secondary to neonatal hypoxic-ischemic encephalopathy) who was undergoing treatment with clonazepam (0.5<span class="elsevierStyleHsp" style=""></span>mg/d), carbamazepine (400<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) and phenobarbital (50<span class="elsevierStyleHsp" style=""></span>mg/d). The patient was diagnosed with chronic hepatitis C more than 20 years ago; she had never received treatment. Over the last 5 years, AST and ALT values increased up to 100<span class="elsevierStyleHsp" style=""></span>IU/L and transient elastography reached 13.6<span class="elsevierStyleHsp" style=""></span>kPa in December 2019. An abdominal ultrasound examination showed a normal liver but a portal vein measuring 13<span class="elsevierStyleHsp" style=""></span>mm and spleen size of 13<span class="elsevierStyleHsp" style=""></span>cm (both suggesting the presence of portal hypertension). After consultation, her neurologist did not consider acceptable to modify/interrupt the current anticonvulsant therapy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We discussed the pros and cons of antiviral treatment with the patient and finally decided to initiate sofosbuvir/velpatasvir for12 weeks. Since we were not able to measure DAA concentrations during treatment, we tested for HCV-RNA every 2–4 weeks. Baseline viral load was 3.662.000<span class="elsevierStyleHsp" style=""></span>IU/mL. At week 2 of therapy HCV-RNA had decreased to 42<span class="elsevierStyleHsp" style=""></span>IU/mL. At week 4 of treatment aminotransferases returned to normal values and HCV-RNA was already undetectable. At weeks 8 and 12 (end of therapy) HCV-RNA remained undetectable. Twelve and 24 weeks after treatment discontinuation HCV load remained below the quantification (SVR12 and SVR24). Transient elastography value decreased to 10<span class="elsevierStyleHsp" style=""></span>kPa at SVR12.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the fact that current clinical guidelines contraindicate the use of DAA in patients who are undergoing treatment with some anticonvulsants,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> we believe that in selected cases (were liver disease may compromise life expectancy) HCV therapy should be considered. Although a decrease of DAA levels during treatment with P-gp or CYP inducers is likely and can be predicted,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">2,3</span></a> the levels at which antiviral efficacy is compromised (in vivo) are no well known. For this reason, frequent determination of viral load during treatment may be helpful to reassure that HCV replication is effectively inhibited during therapy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">No funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">XF acted as advisor for Gilead and Abbvie.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "EASL recommendations on treatment of hepatitis C: Final update of the series. J Hepatol 2020;73:1170–218." ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effective treatment of hepatitis C virus infection with sofosbuvir and daclatasvir 90<span class="elsevierStyleHsp" style=""></span>mg in a patient with severe epilepsy on oxcarbazepine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.J. Smolders" 1 => "C.T.M.M. de Kanter" 2 => "N. van’t Veer" 3 => "A. D’avolio" 4 => "G. Di Perri" 5 => "D.M. Burger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijantimicag.2016.06.005" "Revista" => array:6 [ "tituloSerie" => "Int J Antimicrob Agents" "fecha" => "2016" "volumen" => "48" "paginaInicial" => "342" "paginaFinal" => "348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27451086" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytochrome P450 3A induction predicts P-glycoprotein induction; Part 2: Prediction of decreased substrate exposure after rifabutin or carbamazepine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.D. Lutz" 1 => "B.J. Kirby" 2 => "L. Wang" 3 => "Q. Song" 4 => "J. Ling" 5 => "B. Massetto" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Pharm Therp" "fecha" => "2018" "volumen" => "104" "paginaInicial" => "1191" "paginaFinal" => "1198" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004400000007/v3_202201060648/S2444382421001474/v3_202201060648/en/main.assets" "Apartado" => array:4 [ "identificador" => "48445" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004400000007/v3_202201060648/S2444382421001474/v3_202201060648/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382421001474?idApp=UINPBA00004N" ]
Journal Information
Letter to the Editor
Hepatitis C therapy and anticonvulsants
Tratamiento de la hepatitis C en pacientes con anticonvulsivos
Concepció Bartres, Guillem Soy, Xavier Forns
Corresponding author
Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain