EFFECTS OF PHLEBOTOMY IN PATIENTS WITH CHRONIC HEPATITIS C WHO
FAILED TO RESPOND TO A PRIOR COURSE OF INTERFERON
[alpha]-2B.
Author: JL Herrera. Division of Gastroenterology, University of
South Alabama College of Medicine, Mobile, AL.
To assess if phlebotomy enhances the response to interferon
(IFN) in patients with chronic hepatitis C, we prospectively
evaluated 14 patients who had failed (n=11) or relapsed (n=3) after
a prior course of interferon [alpha]-2b. All patients underwent
weekly phlebotomy until serum ferritin was less than lower limits
of normal. Patients then received interferon [alpha]-2b, 3 M.U.
3X/wk for 24 weeks. No additional phlebotomies were done during
interferon therapy. Serum ALT, ferritin and HCV RNA by PCR and bDNA
were measured at baseline, pre-interferon (after phlebotomy) and at
12 & 24 wks of interferon therapy. Response to treatment was
defined as HCV-RNA PCR negative at the end of treatment. Fourteen
patients, mean age (±SEM) 48±3 yr. (10 M, 4F) were
studied. Liver histology showed mild chronic hepatitis. in 2,
severe chronic hepatitis in 8 and cirrhosis in 4.
Laboratory evaluation:
Baseline Pre-IFN WK 12 WK 24 IFN
(post-phlebotomy) IFN
ALT (U/L) 152±24 99±14 79±14 115±25
FERRITIN 241±80 11±2 20±4 27±9(ng/ml)
HCVRNA 77±18 50±10 30±10 17±4(x10Ø{5})
All values are expressed as mean ± SEM
Significant decrease in ALT (p=0.004) and
bDNA levels (p=0.009) were noted after phlebotomy. No further
significant improvement in ALT was noted on interferon (p=0.45).
Although interferon therapy resulted in further significant
decrease in viremia (p=0.04 pre IFN vs. wk 24 IFN), all patients
were HCV-RNA PCR positive at the end of therapy.
CONCLUSION: Iron deficiency induced by phlebotomy does not
result on viral eradication during interferon therapy in patients
who had previously failed a course of interferon. This research was
funded in part by Schering-Plough, Kenilworth, New Jersey.
Source: American Association for the Study of Liver Diseases
- 1996 Annual Meeting
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