The effects of a high dose, short course of interferon on hepatitis C

[Short-term treatment of Hepatitis C in heroin-dependent patients]

BACKGROUND

Standardized treatment (24-week) with pegylated interferon and ribavirin induces sustained virological response in 80 % of patients with Hepatitis C (HCV) genotype 2 or 3. Most patients who are dependent on heroin and receiving methadone maintenance therapy (MMT) have been excluded from this treatment due to concerns about compliance. Short-term therapy (14 weeks) of other patient groups have shown promising results. The purpose of this study was to investigate the feasibility, efficacy and adverse effects of short-term treatment in a group of MMT patients with chronic hepatitis C infection genotype 3.

MATERIAL AND METHODS

Eight such patients were treated with weekly pegylated interferon injections (180 microg) and daily ribavirin tablets (800 mg) for 14 weeks. A nurse gave the injections and the patients were followed-up closely with weekly meetings, telephone and SMS.

RESULTS

Virus was eradicated in all patients after four weeks (RVR = 100 %). Seven patients completed treatment and all had undetectable virus at 14 weeks (88 %). At follow-up six months post treatment, six patients had sustained virus response (SVR = 75 %), the last patient refused to be tested. The adverse effects were of moderate intensity and could be treated with dose adjustments and supportive therapy, without additional medication. Drug abuse was a minor problem during treatment and no one relapsed to drug injections.

INTERPRETATION

Short-term (14 weeks) therapy with pegylated interferon and ribavirin can then be feasible, efficient and safe for Hepatitis C genotype 3. We stress the importance of close monitoring and support from a multidisciplinary team. MMT is a good opportunity to introduce HCV treatment.

Prospective study of short-term peginterferon-alpha-2a monotherapy in patients who had a virological response at 2 weeks after initiation of interferon therapy

BACKGROUND AND AIMS

Long-term interferon (IFN) therapy is effective in eliminating hepatitis C virus (HCV). However, it carries the risk of adverse effects and reduced quality of life. To assess whether short-term IFN therapy effectively eliminates HCV, we performed a prospective pilot study of pegylated (peg)IFN-alpha-2a therapy for 8 or 24 weeks.

METHODS

After excluding patients with high titers of genotype-1, 55 HCV patients received pegIFN-alpha-2a. Patients who became negative for HCV-RNA at week 2 were allocated to either an 8-week (n = 19) or 24-week (n = 15) course of IFN. We evaluated the efficacy of and tolerance to IFN therapy.

RESULTS

The sustained virological response rate was excellent in the two groups (8 weeks, 89.5% [17/19]; 24 weeks, 100% [15/15], respectively,). IFN dose reduction was required in one patient of the 8-week group, but in six patients of the 24-week group (P = 0.028). Treatment was completed by all patients of the 8-week group, but discontinued in five patients of the 24-week group (P = 0.011).

CONCLUSIONS

The 8-week IFN therapy is more tolerable than the 24-week therapy and had similar outcomes. Excluding the patients with high titers of genotype-1, we recommend switching to an 8-week course of pegIFN-alpha monotherapy once patients show an ultra rapid virological response at week 2 from the start of IFN therapy.

Cost minimisation analysis of 12 or 24 weeks of peginterferon alfa-2b + ribavirin for hepatitis C virus

BACKGROUND

Pegylated interferon and ribavirin are at present the standard treatment for chronic hepatitis C virus (HCV) patients.

OBJECTIVE

The present economic evaluation compared 12 vs. 24 weeks of peginterferon alfa-2b + ribavirin treatments for HCV genotypes 2 or 3. Shortening the period of antiviral therapy is important in terms of adverse events and costs.

METHODS

Clinical evidence was based on the results of a multicentre, randomised controlled clinical trial (RCCT) conducted in Italy, which found that the shorter course of therapy was as effective as the 24-week course for patients with HCV genotypes 2 or 3 responding to treatment at 4 weeks. A cost minimisation analysis was performed. The analysis took the Italian National Health Service (INHS) point of view, thus only healthcare costs (drugs, medical consultations, diagnostic tests, hospital admissions) were considered. Healthcare activities were estimated by the RCCT principal investigators and were priced by applying the INHS tariffs and prices.

RESULTS

The total mean cost per patient was estimated at euro9,785 for the standard group and euro7,508 for the variable-duration group. Sensitivity analysis confirmed the robustness of the baseline results.

CONCLUSIONS

This study showed that the variable-duration regimen can be recommended as an efficient use of resources for patients from the INHS perspective.

Efficacy of low dose long-term interferon monotherapy in aged patients with chronic hepatitis C genotype 1 and its relation to alpha-fetoprotein: A pilot study

AIM

The objective of this study was to examine the efficacy and safety of low dose long-term interferon (IFN) therapy in aged patients with chronic hepatitis C genotype 1.

METHODS

The IFN therapy was performed in Shin-Kokura Hospital on 44 patients aged 60 or older with chronic hepatitis C. All patients had high viral loads of genotype 1. Three million units of natural IFN-alpha was administered intramuscularly or intrasubcutaneously, three times a week for three years. A control group of 44 subjects not treated with IFN, matched for age, gender and hepatic histology, was formed.

RESULTS

Two of the 44 patients showed a sustained virological response. Alanine aminotransferase was below the upper limit of normal in 59% (23/39) of the patients and alpha-fetoprotein was less than 40 ng/mL in 97% (38/39) on the completion of treatment. Sustained biochemical response was observed in 53% (19/36) of the patients. In the liver cirrhosis group, serum albumin values and platelet counts increased in 38% (6/16) and 33% (6/18) of patients, respectively. Hepatocellular carcinoma (HCC) appeared in three patients by 13 months after the start of treatment, but no cases were reported thereafter. The cumulative non-carcinogenesis rate of HCC in the liver cirrhosis group was significantly higher in the IFN treatment group compared to the control group (log-rank test, P = 0.046).

CONCLUSION

Low dose long-term interferon monotherapy to prevent carcinogenesis of HCC was considered useful in aged patients for whom peg-interferon and ribavirin combination therapy is difficult.

Short-term therapy for patients with hepatitis C virus genotype 2 or 3 infection

In the past 10 years, progress has been made in the management of patients with chronic hepatitis C. A sustained virological response (SVR) is achieved in 80-85% of patients infected with hepatitis C virus (HCV) genotype 2 or 3 after 24 weeks of treatment with peginterferon-alpha and ribavirin. Treatment durations <24 weeks have been investigated to determine whether shorter-term therapy reduces adverse effects and costs compared with longer-term therapy without compromising efficacy. Three studies involving only patients with HCV genotype 2 or 3, with different baseline patient characteristics have shown that 12-16 weeks of treatment can be as effective as 24 weeks of treatment. In all three trials, undetectable HCV RNA 4 weeks after the start of treatment was defined as rapid virological response (RVR), and only patients with RVR stopped treatment early. In the first trial, 75% of patients treated with peginterferon-alpha-2b and ribavirin achieved RVR; these rapid responders achieved an SVR rate of 90% after 14 weeks of treatment. In the second trial, 63% of patients achieved RVR after 4 weeks of treatment with peginterferon-alpha-2b and ribavirin, and 85% of patients with RVR achieved SVR after 12 weeks of treatment. In comparison, 91% of patients with RVR treated for 24 weeks had SVR. In the third study, 93% of the total study population achieved RVR and were randomly assigned to 16 or 24 weeks of treatment with peginterferon-alpha-2a and ribavirin. Among patients with RVR, 85% in the group treated for 16 weeks and 80% in the group treated for 24 weeks achieved SVR. Among patients with HCV genotype 2 or 3, achieving an RVR to interferon-based treatment is common and a criterion to reduce the duration of treatment. In patients with genotype 2 and RVR, 12 weeks of therapy with peginterferon-alpha and ribavirin is recommended. For patients with genotype 3, a univocal recommendation on treatment duration cannot be made. However, ongoing trials will probably clarify this aspect.

Treatment with pegylated interferon and ribavarin in HCV infection with genotype 2 or 3 for 14 weeks: a pilot study

The aim of this study was to determine the efficacy of 14 weeks of treatment in patients infected with hepatitis C virus (HCV) genotype 2 or 3 who achieve early virological response (EVR). In a noncontrolled multicenter trial, 122 treatment-naive patients received 1.5 mug/kg pegylated interferon alfa-2b subcutaneously once weekly and 800 to 1,400 mg/d ribavirin based on body weight. Treatment was stopped at week 14 in patients with EVR, defined as undetectable HCV RNA at weeks 4 and 8. Patients without EVR were assigned to 24 weeks of treatment. The primary end point was sustained virological response (SVR), defined as undetectable HCV RNA 24 weeks after end of treatment. Among the 122 patients, 95 (78%) had EVR and received 14 weeks of treatment. The remaining 27 (22%) were treated for 24 weeks. SVR was obtained in 85 (90%) of 95 patients in the 14-week treatment group and 15 of (56%) 27 in the 24-week treatment group. Altogether, SVR was obtained in 100 of 122 patients (82%; 95% CI, 75%-89%). SVR after 14 weeks of treatment was achieved more frequently among genotype 3a patients with low viral load compared with high viral load (98% vs. 79%; P = .019). Logistic regression analysis showed that absence of bridging fibrosis/cirrhosis was the only independent predictor of SVR. In conclusion, patients with genotype 2 or 3 and EVR obtained a high SVR after 14 weeks of treatment. The results need to be confirmed in a randomized, controlled study before this treatment approach can be recommended, particularly for patients with genotype 3 and high viral load or severe fibrosis.

Induction interferon therapy in naïve patients with chronic hepatitis C: increased end-of-treatment virological responses but absence of long-term benefit

BACKGROUND AND AIMS

The low efficacy of interferon monotherapy and data from viral kinetic studies led us to evaluate the efficacy of interferon administered daily in chronic hepatitis C.

PATIENTS AND METHODS

Thirty-eight naïve patients with chronic hepatitis C and active liver disease randomly received 3 or 5 MU IFN-alpha daily for 1 month, followed by the same dose three times a week for 11 months. Results were compared to a three-times-a-week scheme of 3 MU IFN-alpha for 1 year.

RESULTS

At the end of the induction period, 27 out of 38 (71%) patients had cleared HCV-RNA with a significantly higher rate in the 5 MU than in the 3 MU group (17 out of 18 or 94% vs. 10 out of 20 or 50%, P=0.003). The end-of-treatment virological response rate was 66% (25 out of 38) in the induction groups and 40% (10 out of 25) in the control group (P=0.04). Six months after completion of therapy, the sustained response rate dropped to 29% (11 out of 38) compared to 28% (7 out of 25) in the standard regimen.

CONCLUSIONS

In chronic hepatitis C, treatment with 5 or 3 MU IFN-alpha daily during the first month of a standard IFN regimen leads to significantly increased end-of-treatment virological responses, but long-term responses are similar to those of standard IFN monotherapy.