Maintenance Interferon Therapy Benefits HCV-Infected
Patients With Persistent Viremia
WESTPORT, Nov 01 (Reuters Health) - Maintenance therapy with
interferon results in histologic improvement in patients with
chronic hepatitis C (HCV) infection who do not respond to
interferon or interferon/ribavirin combination therapy. These
findings, from a US-based trial, are published in the November
issue of Gastroenterology.
Dr. Mitchell L. Shiffman and colleagues from the Medical College
of Virginia Commonwealth University in Richmond, Virginia, explain
that more than 50% of patients infected with HCV do not respond to
interferon or interferon/ribavirin therapy and are classified as
nonresponders, but that "...histologic improvement is observed in
some nonresponders.
The investigators studied 53 patients who were viremic after 6
months' therapy with interferon-2b but who exhibited a histologic
response. Twenty-seven participants were randomized to maintenance
interferon for 24 months, and 26 were randomized to discontinuation
of interferon therapy. The study team monitored serum alanine
aminotransferase (ALT) levels and HCV RNA titers during this
period, and carried out liver biopsy every 12 months.
According to the paper, there were no significant differences
between the two patient groups with respect to "...mean age, sex,
race or mean values for serum ALT level, HCV RNA titer, or Knodell
score."
The investigators found that despite the persistence of viremia,
patients given continuous interferon therapy maintained the
improvements in hepatic inflammation, serum ALT levels and log HCV
RNA titers seen after the initial 6 months of treatment.
In contrast, "[s]topping treatment was associated with an
increase in serum ALT, log HCV RNA, and hepatic inflammation back
to baseline."
After 30 months of therapy, the investigators found that, in the
cohort maintained on interferon, the mean fibrosis score decreased
from 2.5 to 1.7 and the histology score improved in 80% of
cases.
In the group in whom interferon therapy was discontinued, the
mean fibrosis score increased from 2.2 to 2.4 and hepatic histology
score increased in 30% of patients.
The investigators believe that "[a] larger and longer randomized
controlled trial is now necessary to confirm the observations made
in this study and define the specific population of patients who
could benefit from maintenance interferon therapy."
Gastroenterology 1999;117:1164-1172
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