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Roff L, Colloredo G, Pioltelli P, Bellati G, Pozzi M, Parravicini P, Bellia V, Del Poggio P, Fornaciari G, Ceriani R, Ramella G, Corradi C, Rossini A, Bruno S. Pegylated Interferon-α2b plus Ribavirin: An Efficacious and well-Tolerated Treatment Regimen for Patients with Hepatitis C virus Related Histologically Proven Cirrhosis. Antivir Ther 2008. [DOI: 10.1177/135965350801300506] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Little is known about the efficacy, safety and tolerability of pegylated interferon plus ribavirin treatment in patients with chronic hepatitis C virus (HCV) infection and histologically proven fully established cirrhosis. We aimed here to evaluate the safety of this regimen in such patients and to identify baseline and on-treatment predictors of a sustained virological response (SVR). Methods Patients with histologically proven, HCV-induced cirrhosis were randomized to receive pegylated interferon-α2b (PEG-IFN-α2b; 1.0 μg/kg/week, n=56; group A) or recombinant interferon-α2b (IFN-α2b; 3 million IU three times/week, n=36; group B), each in combination with a weight-based dose of ribavirin (800–1,200 mg/day) for up to 48 weeks. The primary endpoint of the study was the assessment of SVR, defined as undetectable HCV RNA 24 weeks after treatment cessation. Results Overall, 40% (37/93) of patients attained SVR: 44% (25/57) in group A and 33% (12/36) in group B ( P=0.31). SVR rates were significantly higher in genotype 2/3 patients than in genotype 1 patients (69% versus 25%; P<0.0001). Platelet count at baseline, rapid virological response, and early virological response were predictors of SVR. Twelve patients discontinued treatment because of an adverse event and 20 patients required ribavirin dose reduction for the management of anaemia. Conclusions PEG-IFN-α2b plus ribavirin for 48 weeks is an efficacious and well-tolerated treatment regimen for patients with HCV-induced cirrhosis. Although SVR rates were more satisfactory in genotype 2/3 than in genotype 1 patients, our study identified additional predictors of response that could allow physicians to better manage treatment in this ‘difficult-to-cure’ subset of patients.
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Affiliation(s)
- Luigi Roff
- Department of Internal Medicine, Azienda Ospedaliera della Valtellina e della Valchiavenna, Sondrio, Italy
| | - Guido Colloredo
- Department of Internal Medicine, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Pietro Pioltelli
- Department of Internal Medicine, Azienda Ospedaliera San Gerardo, Università Milano-Bicocca, Monza, Italy
| | - Giorgio Bellati
- Department of Internal Medicine, Azienda Ospedaliera Santa Anna, Como, Italy
| | - Massimo Pozzi
- Department of Internal Medicine, Azienda Ospedaliera San Gerardo, Università Milano-Bicocca, Monza, Italy
| | - Pierpaolo Parravicini
- Department of Internal Medicine, Azienda Ospedaliera della Valtellina e della Valchiavenna, Sondrio, Italy
| | - Valentina Bellia
- Department of Internal Medicine, Azienda Ospedaliera della Valtellina e della Valchiavenna, Sondrio, Italy
| | - Paolo Del Poggio
- Department of Internal Medicine, Azienda Ospedaliera Treviglio, Italy
| | - Giovanni Fornaciari
- Department of Internal Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Roberto Ceriani
- Department of Internal Medicine, Istituto Clinico Humanitas, Milan, Italy
| | - Giuliano Ramella
- Department of Internal Medicine, Azienda Ospedaliera di Melegnano, Italy
| | - Chiara Corradi
- Department of Internal Medicine, Azienda Ospedaliera Santa Anna, Como, Italy
| | - Angelo Rossini
- Department of Internal Medicine, Ospedale Civile, Brescia, Italy
| | - Savino Bruno
- Internal Medicine and Liver Unit, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
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Simin M, Brok J, Stimac D, Gluud C, Gluud LL. Cochrane systematic review: pegylated interferon plus ribavirin vs. interferon plus ribavirin for chronic hepatitis C. Aliment Pharmacol Ther 2007; 25:1153-62. [PMID: 17451561 DOI: 10.1111/j.1365-2036.2007.03294.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND About 170 million patients worldwide have chronic hepatitis C. Pegylated interferon plus ribavirin is currently the recommended therapy. AIM To evaluate the beneficial and harmful effects of pegylated interferon plus ribavirin vs. interferon plus ribavirin for chronic hepatitis C infection. METHODS We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, Science Citation Index Expanded and contacted pharmaceutical companies and authors of trials (to March 2005). RESULTS We included 18 randomized clinical trials with 4811 patients. Eleven trials (61%) had allocation bias risks and all had assessment bias risk because of lack of blinding. Compared with interferon plus ribavirin, pegylated interferon plus ribavirin had significant beneficial effects on sustained virological response [risk ratio (RR): 0.80; 95% CI: 0.74-0.88]. Data were insufficient to determine impact on long-term outcomes. Pegylated interferon plus ribavirin significantly increased dose reductions (RR: 1.44; 95% CI: 1.14-1.82) and adverse events including neutropenia (RR: 2.25; 95% CI: 1.58-3.21), thrombocytopenia (RR: 2.28; 95% CI: 1.14-4.54), arthralgia (RR: 1.19; 95% CI: 1.05-1.35), and injection-site reaction (RR: 2.56; 95% CI: 1.06-6.22). CONCLUSIONS Pegylated interferon plus ribavirin compared with interferon plus ribavirin increased the proportion of patients with sustained virological response, but at the cost of more adverse events.
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Affiliation(s)
- M Simin
- The Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Simin M, Myers RP, Stimac D, Gluud C. Pegylated interferon for acute hepatitis C. Hippokratia 2007. [DOI: 10.1002/14651858.cd006392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Marija Simin
- Laessøegade 18B, 1 th Copenhagen N Denmark DK-2200
| | - Robert P Myers
- AHFMR Clinical Investigator; Director, Viral Hepatitis Unit; University of Calgary Calgary Canada AB T2N 4N1
| | - Davor Stimac
- Clinical Hospital Centre of Rijeka; Clinics of Internal Medicine - Gastroenterology; Kresimirova 42 Rijeka Croatia 51 000
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 3344, Rigshospitalet, Copenhagen University Hospital; Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
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