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Updated: Apr 26, 2026

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eGFR decrease during antiviral C therapy with first generation protease inhibitors: a clinical significance?

Véronique Loustaud-Ratti1, Annick Rousseau, Paul Carrier

  • 1Service d'Hépato-gastroentérologie, CHU de Limoges, 2 avenue Martin-Luther-King, 87042, Limoges, France; Inserm UMR 1092, Faculté de médecine de Limoges, Université de Limoges, Limoges, France.

Liver International : Official Journal of the International Association for the Study of the Liver
|July 22, 2014
PubMed
Summary

First-generation protease inhibitors like telaprevir caused a temporary, benign decrease in estimated glomerular filtration rate (eGFR) in HCV patients. This eGFR decline primarily depends on baseline eGFR and may be linked to OCT2 inhibition, not true renal toxicity.

Keywords:
boceprevirhepatitis C virusrenal impairmenttelaprevir

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Area of Science:

  • Hepatology
  • Nephrology
  • Pharmacology

Background:

  • First-generation protease inhibitors (PIs) showed no renal toxicity in early trials.
  • Recent studies suggest potential renal adverse events with PIs.
  • Clinical significance of these findings requires investigation.

Purpose of the Study:

  • To determine the clinical significance of renal toxicity associated with first-generation protease inhibitors.
  • To analyze the impact of telaprevir and boceprevir on estimated glomerular filtration rate (eGFR).

Main Methods:

  • Retrospective analysis of 101 HCV patients receiving triple or double therapy.
  • Close monitoring of eGFR using the MDRD formula during and after treatment.
  • Assessment of eGFR decline over time using a linear mixed-effects model (LMEM).

Main Results:

  • Telaprevir treatment led to a significant eGFR decrease, with a nadir at week 8 (mean decrease 17.0 ± 18.9 ml/min/1.73 m²), returning to baseline by week 16.
  • eGFR nadir was predictable from baseline eGFR (D0 eGFR).
  • Baseline eGFR was associated with older age and male sex in multivariate analysis.

Conclusions:

  • eGFR significantly varied only in the telaprevir group.
  • The observed early eGFR decrease in the telaprevir group may be a benign phenomenon due to OCT2 inhibition.
  • Thorough eGFR follow-up is recommended due to the possibility of unpredictable renal toxicity.