PegIFN vs Standard IFN in Posttransplant Hepatitis C
PegIFN vs Standard IFN in Posttransplant Hepatitis C
Background: In the treatment of hepatitis C virus (HCV) infection, regimens including pegylated interferon-α are superior to those including standard interferon; the present retrospective study was performed to verify whether the same is applicable to biopsy-proven recurrent hepatitis C (genotype 1b) after liver transplantation (OLT).
Methods: Twenty-four patients (16 male) were studied. Twelve had received interferon-α2b (IFN), 9 MU weekly and 12 received pegylated interferon-α2b (PEG-IFN), 0.5 μg/kg weekly. All had received oral ribavirin 600-800 mg/day. Treatment duration was intended for 12 months. A repeat liver biopsy, with evaluation of the Ishak grading and staging scores, was obtained at 1 year.
Results: Only 12/24 patients (50%) completed a full year of therapy; 17 (71%) experienced side-effects requiring a 50% dosage reduction or discontinuation of the IFN, PEG-IFN and/or ribavirin. This was observed in 6/12 patients (50%) treated with IFN in comparison to 11/12 patients (92%) treated with PEG-IFN ( P < 0.05). The difference was mainly accounted for by anemia and leukopenia that were reported in 4/12 IFN patients (33%) versus 9/12 PEG-IFN patients (75%; P < 0.05), respectively. End-of-treatment viral response (ETVR) and histological response were always associated and occurred in 4/24 patients (17%), two in each treatment arm. Patients with ETVR were younger, had always completed 1 year of therapy, had had recurrent hepatitis later after transplantation and presented a higher baseline grading score.
Conclusions: In the OLT setting, the potential benefits of antiviral treatments including PEG-IFN may be limited by the poor tolerability of the adopted drugs.
Recurrence of hepatitis C virus (HCV) infection after liver transplantation is almost universal, and is followed, in a significant proportion of patients, by early progression to fibrosis, reducing both patient and graft survival. Because HCV-related liver disease is among the most common indications for liver transplantation, an effective treatment for recurrent hepatitis C is eagerly waited.
To date, the most effective treatment to prevent disease progression and to cure infection in chronic hepatitis C consists in the association of pegylated interferon-α and ribavirin. Immunocompetent patients undergoing this antiviral regimen can expect rates of sustained viral response ranging from 42% to approximately 80%, depending on the HCV genotype, with an acceptable safety profile. Thus, in many centers, pegylated interferon-α has replaced standard interferon-α in the regimens used to treat recurrent hepatitis C. However, the advantages, if any, of such approach in the post-transplantation setting, with the additional cost that it entails, remain to be demonstrated.
The aim of the present retrospective study was to compare efficacy and tolerability of the antiviral treatments employing either standard interferon-α2b (IFN) or pegylated interferon-α2b (PEG-IFN) in association with ribavirin, in hepatitis C (genotype HCV-1b) recurrent after liver transplantation. In addition, factors associated with positive viral response and histological improvement after antiviral therapy have been explored.
Background: In the treatment of hepatitis C virus (HCV) infection, regimens including pegylated interferon-α are superior to those including standard interferon; the present retrospective study was performed to verify whether the same is applicable to biopsy-proven recurrent hepatitis C (genotype 1b) after liver transplantation (OLT).
Methods: Twenty-four patients (16 male) were studied. Twelve had received interferon-α2b (IFN), 9 MU weekly and 12 received pegylated interferon-α2b (PEG-IFN), 0.5 μg/kg weekly. All had received oral ribavirin 600-800 mg/day. Treatment duration was intended for 12 months. A repeat liver biopsy, with evaluation of the Ishak grading and staging scores, was obtained at 1 year.
Results: Only 12/24 patients (50%) completed a full year of therapy; 17 (71%) experienced side-effects requiring a 50% dosage reduction or discontinuation of the IFN, PEG-IFN and/or ribavirin. This was observed in 6/12 patients (50%) treated with IFN in comparison to 11/12 patients (92%) treated with PEG-IFN ( P < 0.05). The difference was mainly accounted for by anemia and leukopenia that were reported in 4/12 IFN patients (33%) versus 9/12 PEG-IFN patients (75%; P < 0.05), respectively. End-of-treatment viral response (ETVR) and histological response were always associated and occurred in 4/24 patients (17%), two in each treatment arm. Patients with ETVR were younger, had always completed 1 year of therapy, had had recurrent hepatitis later after transplantation and presented a higher baseline grading score.
Conclusions: In the OLT setting, the potential benefits of antiviral treatments including PEG-IFN may be limited by the poor tolerability of the adopted drugs.
Recurrence of hepatitis C virus (HCV) infection after liver transplantation is almost universal, and is followed, in a significant proportion of patients, by early progression to fibrosis, reducing both patient and graft survival. Because HCV-related liver disease is among the most common indications for liver transplantation, an effective treatment for recurrent hepatitis C is eagerly waited.
To date, the most effective treatment to prevent disease progression and to cure infection in chronic hepatitis C consists in the association of pegylated interferon-α and ribavirin. Immunocompetent patients undergoing this antiviral regimen can expect rates of sustained viral response ranging from 42% to approximately 80%, depending on the HCV genotype, with an acceptable safety profile. Thus, in many centers, pegylated interferon-α has replaced standard interferon-α in the regimens used to treat recurrent hepatitis C. However, the advantages, if any, of such approach in the post-transplantation setting, with the additional cost that it entails, remain to be demonstrated.
The aim of the present retrospective study was to compare efficacy and tolerability of the antiviral treatments employing either standard interferon-α2b (IFN) or pegylated interferon-α2b (PEG-IFN) in association with ribavirin, in hepatitis C (genotype HCV-1b) recurrent after liver transplantation. In addition, factors associated with positive viral response and histological improvement after antiviral therapy have been explored.
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