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Kuwashiro T, Iwane S, Jinghe X, Matsuhashi S, Eguchi Y, Anzai K, Fujimoto K, Mizuta T, Sakamoto N, Ikeda M, Kato N, Ozaki I. Regulation of interferon signaling and HCV‑RNA replication by extracellular matrix. Int J Mol Med 2018; 42:957-965. [PMID: 29786754 PMCID: PMC6034922 DOI: 10.3892/ijmm.2018.3693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/09/2018] [Indexed: 01/08/2023] Open
Abstract
Although interferon (IFN)‑based treatment of patients with chronic hepatitis C virus (HCV) infection is widely applied, treatment resistance is often observed in patients with advanced liver fibrosis. Given that the molecular mechanisms of IFN resistance in liver fibrosis remain elusive, the present study investigated the effects of extracellular matrix (ECM) on IFN signaling in hepatic cells. The native HuH‑7 human hepatoma cell line and HuH‑7 cells were stably transfected with full‑length HCV‑RNA fused with Renilla luciferase (OR6 cells) were cultured on ECM‑coated dishes or non‑coated plastic dishes (NDs), and treated with human IFN‑α. In Huh‑7 cells cultured on coated dishes, the IFN‑stimulated response element (ISRE) luciferase activity was measured following ISRE plasmid transfection and the expression of IFN‑stimulated genes (ISG) were significantly lower than those in cells cultured on NDs. In addition, after IFN‑α treatment, the amount of HCV‑RNA and viral protein produced by OR6 cells cultured on coated dishes was higher than that produced by cells cultured on NDs. When cells were treated with β1‑integrin‑blocking antibody to disrupt the cell‑matrix interaction, the ISRE luciferase activity was restored, and the protein expression of ISG was increased, while that of HCV proteins was suppressed. Treatment of cells with integrin‑linked kinase (ILK) inhibitor or focal adhesion kinase (FAK) inhibitor restored the ISRE luciferase activity and expression of ISG proteins. These results suggested that β1‑integrin‑mediated signals affected the IFN signaling and promoted HCV replication. Therefore, the accumulation of ECM in liver fibrosis may impair IFN signaling through β1‑integrin‑mediated signaling involving ILK and FAK.
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Affiliation(s)
- Takuya Kuwashiro
- Department of Internal Medicine, Saga Medical School, Saga University, Saga 849‑8501, Japan
| | - Shinji Iwane
- Department of Internal Medicine, Saga Medical School, Saga University, Saga 849‑8501, Japan
| | - Xia Jinghe
- Department of Internal Medicine, Saga Medical School, Saga University, Saga 849‑8501, Japan
| | - Sachiko Matsuhashi
- Department of Internal Medicine, Saga Medical School, Saga University, Saga 849‑8501, Japan
| | - Yuichiro Eguchi
- Department of Internal Medicine, Saga Medical School, Saga University, Saga 849‑8501, Japan
| | - Keizo Anzai
- Department of Internal Medicine, Saga Medical School, Saga University, Saga 849‑8501, Japan
| | - Kazuma Fujimoto
- Department of Internal Medicine, Saga Medical School, Saga University, Saga 849‑8501, Japan
| | - Toshihiko Mizuta
- Department of Internal Medicine, Saga Medical School, Saga University, Saga 849‑8501, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido 060‑8638, Japan
| | - Masanori Ikeda
- Department of Tumor Virology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan
| | - Nobuyuki Kato
- Department of Tumor Virology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan
| | - Iwata Ozaki
- Department of Internal Medicine, Saga Medical School, Saga University, Saga 849‑8501, Japan
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Resende C, Pereira T, Ventura F, Brito C. Leg ulcer as a manifestation of eosinophilic vasculitis in a patient with hepatitis C virus infection, medicated with pegylated interferon/ribavirin. BMJ Case Rep 2015; 2015:bcr-2015-209377. [PMID: 26065548 DOI: 10.1136/bcr-2015-209377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cryoglobulinaemic vasculitis is a complication of hepatitis C virus (HCV) infection, responding to treatment with pegylated interferon (peg-IFN)/ribavirin (RIB), but vasculitis may first appear after treatment with peg-IFN/RIB. A 35-year-old man with HCV infection presented to our department with a 2-month history of a 3.3 × 3 cm ulcer localised on the right shin, with a regular border, on a violaceous base. Histopathological examination revealed a leucocytoclastic vasculitis, rich in eosinophils. The patient had been treated with peg-IFN/RIB 10 months prior and treatment was discontinued after 2 months because of the appearance of arthralgias and neuropathy. Laboratory investigations revealed positive cryoglobulins, elevation of rheumatoid factor and reduction of C4 after treatment with peg-IFN/RIB. Dressings with a hydrocellular foam were placed and after 2 months the ulcer resolved. We presented this case because of the rarity of development of a cryoglobulinaemic vasculitis in a patient with HCV infection, previously treated with peg-IFN/RIB.
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Affiliation(s)
- Cristina Resende
- Department of Dermatology and Venereology, Hospital de Braga, Braga, Portugal
| | - Teresa Pereira
- Department of Dermatology and Venereology, Hospital de Braga, Braga, Portugal
| | - Filipa Ventura
- Department of Dermatology and Venereology, Hospital de Braga, Braga, Portugal
| | - Celeste Brito
- Department of Dermatology and Venereology, Hospital de Braga, Braga, Portugal
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Ikeda N, Imanishi H, Aizawa N, Tanaka H, Iwata Y, Enomoto H, Saito M, Iijima H, Iimuro Y, Fujimoto J, Yamamoto S, Hirota S, Kudo M, Arii S, Nishiguchi S. Nationwide survey in Japan regarding splenectomy/partial splenic embolization for interferon treatment targeting hepatitis C virus-related chronic liver disease in patients with low platelet count. Hepatol Res 2014; 44:829-36. [PMID: 23763386 DOI: 10.1111/hepr.12184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/04/2013] [Accepted: 06/10/2013] [Indexed: 01/06/2023]
Abstract
AIM In chronic liver disease associated with hepatitis C virus (HCV), a low platelet count is a major obstacle in carrying out interferon (IFN) treatment. We used a questionnaire to clarify the extent to which splenectomy/partial splenic embolization (PSE) is performed before IFN treatment, as well as the efficacy and complications thereof. METHODS Two questionnaires were distributed to 413 medical institutes in Japan specializing in the treatment of liver diseases, and responses were obtained from 204 institutes. Furthermore, a more detailed questionnaire was completed by 10 institutes that experienced cases of death. RESULTS In patients with HCV genotype 1b and a high viral load (HCV1b/High), the sustained viral response (SVR) rate was 28% for the splenectomy group and 22% for the PSE group, with no significant difference between these groups. In patients that were not HCV1b/High, the SVR rate was higher in those that underwent splenectomy (71%) compared to the PSE group (56%; P = 0.025). There were cases of death in seven of 799 splenectomy cases (0.89%) and four of 474 PSE cases (0.84%). Infectious diseases were involved in nine of 11 cases of death, with a peculiar patient background of Child-Pugh B (6/10) and an age of 60 years or greater (7/11). CONCLUSION The application of splenectomy/PSE before IFN treatment should be avoided in patients with poor residual hepatic function and/or elderly patients. In HCV1b/High patients, splenectomy/PSE should be performed only after selecting those in which IFN treatment should be highly effective.
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Affiliation(s)
- Naoto Ikeda
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Hézode C, Fontaine H, Dorival C, Zoulim F, Larrey D, Canva V, De Ledinghen V, Poynard T, Samuel D, Bourliere M, Alric L, Raabe JJ, Zarski JP, Marcellin P, Riachi G, Bernard PH, Loustaud-Ratti V, Chazouilleres O, Abergel A, Guyader D, Metivier S, Tran A, Di Martino V, Causse X, Dao T, Lucidarme D, Portal I, Cacoub P, Gournay J, Grando-Lemaire V, Hillon P, Attali P, Fontanges T, Rosa I, Petrov-Sanchez V, Barthe Y, Pawlotsky JM, Pol S, Carrat F, Bronowicki JP. Effectiveness of telaprevir or boceprevir in treatment-experienced patients with HCV genotype 1 infection and cirrhosis. Gastroenterology 2014; 147:132-142.e4. [PMID: 24704719 DOI: 10.1053/j.gastro.2014.03.051] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 03/20/2014] [Accepted: 03/31/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS We investigated the effectiveness of the protease inhibitors peginterferon and ribavirin in treatment-experienced patients with hepatitis C virus (HCV) genotype 1 infection and cirrhosis. METHODS In the Compassionate Use of Protease Inhibitors in Viral C Cirrhosis study, 511 patients with HCV genotype 1 infection and compensated cirrhosis who did not respond to a prior course of peginterferon and ribavirin (44.3% relapsers or patients with viral breakthrough, 44.8% partial responders, and 8.0% null responders) were given either telaprevir (n = 299) or boceprevir (n = 212) for 48 weeks. We assessed percentages of patients with sustained viral responses 12 weeks after therapy and safety. This observational study did not allow for direct comparison of the 2 regimens. RESULTS Among patients given telaprevir, 74.2% of relapsers, 40.0% of partial responders, and 19.4% of null responders achieved SVR12. Among those given boceprevir, 53.9% of relapsers, 38.3% of partial responders, and none of the null responders achieved SVR12. In multivariate analysis, factors associated with SVR12 included prior response to treatment response, no lead-in phase, HCV subtype 1b (vs 1a), and baseline platelet count greater than 100,000/mm(3). Severe adverse events occurred in 49.9% of cases, including liver decompensation, severe infections in 10.4%, and death in 2.2%. In multivariate analysis, baseline serum albumin level less than 35 g/L and baseline platelet counts of 100,000/mm(3) or less predicted severe side effects or death. CONCLUSIONS Relatively high percentages of real-life, treatment-experienced patients with HCV genotype 1 infection and cirrhosis respond to the combination of peginterferon and ribavirin with telaprevir or boceprevir. However, side effects are frequent and often severe. Baseline levels of albumin and platelet counts can be used to guide treatment decisions. ClinicalTrials.gov number: NCT01514890.
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Affiliation(s)
- Christophe Hézode
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - Helene Fontaine
- Department of Hepatology, Hôpital Cochin, AP-HP, Université Paris-René Descartes, INSERM U1016, Paris, France
| | - Celine Dorival
- INSERM UMR-S 1136, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Fabien Zoulim
- Department of Hepatology, Hospices Civils de Lyon, INSERM U1052, Université de Lyon, Lyon, France
| | - Dominique Larrey
- Liver Unit-IRB-INSERM1040, Hôpital Saint Eloi, Montpellier, France
| | - Valerie Canva
- Department of Hepatology and Gastroenterology, Centre Hospitalier Régional et Universitaire Claude Huriez, Lille, France
| | - Victor De Ledinghen
- Department of Hepatology and Gastroenterology, Hôpital Haut-Lévêque, Pessac, INSERM U1053, Université Bordeaux Segalen, Bordeaux, France
| | - Thierry Poynard
- Department of Hepatology and Gastroenterology, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 6, INSERM UMR-S938, Paris, France
| | - Didier Samuel
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, UMR-S785, Université Paris-Sud, INSERM U785, Villejuif, France
| | - Marc Bourliere
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, UMR-152, Toulouse III University, Toulouse, France
| | - Jean-Jacques Raabe
- Department of Hepatology and Gastroenterology, Centre Hospitalier Régional, Metz, France
| | - Jean-Pierre Zarski
- Department of Hepatology and Gastroenterology, Centre Hospitalo-Universitaire, INSERM U823, Grenoble, France
| | - Patrick Marcellin
- Department of Hepatology, Hôpital Beaujon, AP-HP, Université Paris-Diderot, INSERM CRB3, Clichy, France
| | - Ghassan Riachi
- Department of Hepatology and Gastroenterology, CHU Charles Nicolle, Rouen, France
| | - Pierre-Henri Bernard
- Service d'Hépatologie et Gastroentérologie, Hôpital Saint-André, Bordeaux, INSERM U1053, Université Bordeaux Segalen, Bordeaux, France
| | - Veronique Loustaud-Ratti
- Department of Hepatology and Gastroenterology, CHU Dupuytren, Université de Limoges, UMR INSERM U1092, Limoges, France
| | | | - Armand Abergel
- Department of Hepatology and Gastroenterology, CHU Estaing, Université d'Auvergne, UMR 6284, Clermont-Ferrand, France
| | - Dominique Guyader
- Service des Maladies du Foie, CHU Rennes, Université de Rennes 1, INSERM U991, Rennes, France
| | - Sophie Metivier
- Department of Hepatology and Gastroenterology, CHU Purpan, Toulouse, France
| | - Albert Tran
- Digestive Center, Centre Hospitalier Universitaire de Nice, INSERM U1065-8, Nice, France
| | - Vincent Di Martino
- Service d'Hépatologie, CHU Jean Minjoz, Université de Franche Comté, Besançon, France
| | - Xavier Causse
- Department of Hepatology and Gastroenterology and Digestive Oncology, CHR La Source, Orléans, France
| | - Thong Dao
- Department of Hepatology and Gastroenterology, CHU, INSERM U1075, Caen, France
| | - Damien Lucidarme
- Department of Hepatology and Gastroenterology, Groupe Hospitalier de l'Institut Catholique Lillois, Faculté Libre de Médecine, Lille, France
| | - Isabelle Portal
- Department of Hepatology and Gastroenterology, Hôpital de la Conception, Marseille, France
| | - Patrice Cacoub
- Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Pierre et Marie Curie Paris 6, INSERM, UMR-S959, CNRS, UMR 7211, Paris, France
| | - Jerome Gournay
- Department of Hepatology and Gastroenterology, Hôpital Hôtel-Dieu, Nantes, France
| | - Veronique Grando-Lemaire
- Department of Hepatology and Gastroenterology, Hôpital Jean Verdier, AP-HP, Université Paris 13, Bondy, France
| | - Patrick Hillon
- Department of Hepatology and Gastroenterology, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Pierre Attali
- Department of Hepatology and Gastroenterology, Hôpital de Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Thierry Fontanges
- Department of Hepatology and Gastroenterology, Hôpital P Oudot, Bourgoin-Jallieu, France
| | - Isabelle Rosa
- Department of Hepatology and Gastroenterology, Centre Hospitalier Intercommunal, Créteil, France
| | - Ventzislava Petrov-Sanchez
- Unit for Basic and Clinical Research on Viral Hepatitis, French National Agency for Research on AIDS and Viral Hepatitis, Paris, France
| | - Yoann Barthe
- INSERM UMR-S 1136, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Jean-Michel Pawlotsky
- National Reference Center for Viral Hepatitis B, C and Delta, Department of Virology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - Stanislas Pol
- Department of Hepatology, Hôpital Cochin, AP-HP, Université Paris-René Descartes, INSERM U1016, Paris, France
| | - Fabrice Carrat
- INSERM UMR-S 1136, Université Pierre et Marie Curie Paris 6, Paris, France; Department of Public Health, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Jean-Pierre Bronowicki
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, INSERM U954, Vandoeuvre-les-Nancy, France.
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Triple therapy in treatment-experienced patients with HCV-cirrhosis in a multicentre cohort of the French Early Access Programme (ANRS CO20-CUPIC) - NCT01514890. J Hepatol 2013; 59:434-41. [PMID: 23669289 DOI: 10.1016/j.jhep.2013.04.035] [Citation(s) in RCA: 370] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 04/05/2013] [Accepted: 04/25/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS In phase III trials, the safety profile of triple therapy (pegylated interferon/ribavirin with boceprevir or telaprevir) seems to be similar in HCV treatment-experienced cirrhotic and non-cirrhotic patients, but few cirrhotics were included. We report the week 16 safety and efficacy analysis in a cohort of compensated cirrhotics treated in the French Early Access Programme. METHODS 674 genotype 1 patients, prospectively included, received 48 weeks of triple therapy. The analysis is restricted to 497 patients reaching week 16. RESULTS A high incidence of serious adverse events (40.0%), and of death and severe complications (severe infection or hepatic decompensation) (6.4%), and a difficult management of anaemia (erythropoietin and transfusion use in 50.7% and 12.1%) were observed. Independent predictors of anaemia < 8 g/dl or blood transfusion were: female gender (OR 2.19, 95% CI 1.11-4.33, p=0.024), no lead-in phase (OR 2.25, 95% CI 1.15-4.39, p=0.018), age ≥ 65 years (OR 3.04, 95% CI 1.54-6.02, p=0.0014), haemoglobin level (≤ 12 g/dl for females, ≤ 13 g/dl for males) (OR 5.30, 95% CI 2.49-11.5, p=0.0001). Death or severe complications were related to platelets count ≤ 100,000/mm(3) (OR 3.11, 95% CI 1.30-7.41, p=0.0105) and albumin <35 g/dl (OR 6.33, 95% CI 2.66-15.07, p=0.0001), with a risk of 44.1% in patients with both. However, the on-treatment virological response was high. CONCLUSIONS The safety profile was poor and patients with platelet count ≤ 100,000/mm(3) and serum albumin <35 g/L should not be treated with the triple therapy.
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Lee HS, Kweon YO, Tak WY, Park SY, Kang EJ, Lee YL, Yang HM, Park HW. Advanced fibrosis is not a negative pretreatment predictive factor for genotype 2 or 3 chronic hepatitis C patients. Clin Mol Hepatol 2013; 19:148-55. [PMID: 23837139 PMCID: PMC3701847 DOI: 10.3350/cmh.2013.19.2.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 05/06/2013] [Accepted: 05/09/2013] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Chronic hepatitis C patients with advanced fibrosis have unsatisfactory sustained virological response (SVR) rates. Few data demonstrating the efficacy of combination therapy in chronic hepatitis C patients with advanced fibrosis in South Korea are available. The purpose of this study was to assess whether the stage of fibrosis impacts the efficacy of combination therapy for chronic hepatitis C. Methods We retrospectively reviewed data for a total of 109 patients with chronic hepatitis C, treated with peginterferon alfa and ribavirin. SVR according to the stage of liver fibrosis assessed by pretreatment liver biopsy and genotype results were analyzed. Results Data from 66 genotype 1 patients (60.6%) and 43 genotype 2 or 3 patients (39.4%) among the 109 patients were analyzed. SVR rates for the genotype 1 patients were significantly lower for the stage 3-4 group (32.1%) than the stage 0-2 group (78.9%; P<0.001). SVR rates (92.0% for stage 0-2, 77.8% for stage 3-4, P=0.184) of genotype 2 or 3 patients were not significantly different according to fibrosis stage. Likewise, the frequency of adverse events was not significantly different according to fibrosis stage. Conclusions Compared to patients without advanced fibrosis, we can anticipate good SVR rates for genotype 2 or 3 patients with advanced fibrosis and they did not show an inferior tolerability for peginterferon and ribavirin combination therpy. Our results suggest that active treatment is needed for genotype 2 or 3 patients with advanced fibrosis.
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Affiliation(s)
- Hyun Seok Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu, Korea
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Trapero-Marugán M, Mendoza J, Moreno Monteagudo JA, Chaparro M, García-Buey L, González-Moreno L, Borque MJ, Moreno-Otero R. Current antiviral combination therapy for chronic hepatitis C patients who failed to interferon alfa-based treatment. J Clin Pharm Ther 2010; 36:695-703. [PMID: 21175705 DOI: 10.1111/j.1365-2710.2010.01231.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Interferon-alfa-based therapy is effective in the treatment of Hepatitis C. However, some patients fail to respond and others relapse, after initially responding. Our objective was to assess the efficacy, safety and predictive factors for sustained virological response (SVR) to peginterferon plus ribavirin in chronic hepatitis C patients who failed to interferon-alfa (IFNα)-based therapy. METHODS Seventy-five consecutive patients who failed to IFNα-based therapy were retreated with peginterferon plus ribavirin. Of these patients, 85% were infected by genotype 1. The primary endpoint was SVR. RESULTS AND DISCUSSION Of 75 non-responder (n = 54) or relapser patients (n = 21), 50 were previously treated with IFNα-monotherapy and 25 with IFNα plus ribavirin. Global SVR rate was 41.3%: for patients re-treated with IFNα the response was 48% whilst for those retreated with IFNα plus ribavirin, it was 28%. For previous non-responders the SVR rate was 37% and for relapsers it was 52.4%. WHAT IS NEW AND CONCLUSION Retreatment with peginterferon plus ribavirin is an effective option for some chronic hepatitis C non-responder or relapser patients. Higher SVR rate was achieved in relapsers and in those patients who received IFNα monotherapy previously.
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Affiliation(s)
- M Trapero-Marugán
- Gastroenterology and Hepatology Service, Hospital Universitario de La Princesa, Autonomous University of Madrid, and Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
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Noureddin M, Ghany MG. Editorial: Treatment of patients with HCV-related cirrhosis with peginterferon and ribavirin: Swinging the pendulum toward treatment. Am J Gastroenterol 2010; 105:2174-6. [PMID: 20927065 PMCID: PMC7725429 DOI: 10.1038/ajg.2010.288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with hepatitis C virus-related cirrhosis are at increased risk for hepatic decompensation and hepatocellular carcinoma (HCC). They also responded less well to standard therapy compared with those without cirrhosis. Several recent studies have demonstrated that patients with cirrhosis can be safely treated and those who achieve a sustained virological response have better clinical outcomes compared with nonresponders. These results support treatment for patients with compensated cirrhosis. In addition, cirrhotic patients should be monitored after a sustained virological response is obtained, because some patients remain at risk for complications of liver disease, particularly HCC. Newer, more effective therapy is needed for patients with cirrhosis.
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Cheng WSC, Roberts SK, McCaughan G, Sievert W, Weltman M, Crawford D, Rawlinson W, Marks PS, Thommes J, Rizkalla B, Yoshihara M, Dore GJ. Low virological response and high relapse rates in hepatitis C genotype 1 patients with advanced fibrosis despite adequate therapeutic dosing. J Hepatol 2010; 53:616-23. [PMID: 20619475 DOI: 10.1016/j.jhep.2010.04.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 03/19/2010] [Accepted: 04/11/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The impact of fibrosis stage on chronic hepatitis C virus (HCV) treatment response was explored in CHARIOT, a study of high dose peginterferon alfa-2a (PEG-IFNalpha-2a) induction therapy in treatment naïve genotype 1 infection. METHODS Eight hundred and ninety-six patients were randomised 1:1 to 360 microg (n=448) or 180 microg (n=448) PEG-IFNalpha-2a weekly with RBV 1000-1200 mg/day for 12 weeks followed by 36 weeks of 180 microg PEG-IFNalpha-2a weekly plus RBV 1000-1200 mg/day. Virological responses were assessed at week 4, 8, 12, 24, 48 (end of therapy), and 24 weeks following therapy (sustained virological response, SVR). As previously reported, there was no significant difference in SVR in the induction (53%) and standard (50%) arms, therefore the pooled study population was used for analysis of SVR and relapse. RESULTS A marked step-wise decline in SVR was evident by fibrosis stage: F0 (70%); F1 (60%); F2 (51%); F3 (31%); F4 (10%) (p<0.0001). Early virological responses were lower among F3/4 patients, including rapid virological response (RVR) (21% vs. 34% for F3/4 and F0-2, respectively) (p=0.0072), and the RVR positive predictive value was also lower (63% vs. 80%). Virological relapse rates were similar in early disease stages (F0, 16%; F1, 23%; F2, 26%), but increased markedly in advanced fibrosis (F3, 50%; F4, 80%) (p<0.0001). Cumulative PEG-IFNalpha-2a and ribavirin doses were similar among patients with F3/4 and F0-2 within treatment arms through week 4, 8, 12, and week 24. CONCLUSIONS Low virological response in hepatitis C genotype 1 patients with advanced fibrosis is not explained by inadequate cumulative PEG-IFN and ribavirin doses.
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Practice guidelines for the treatment of hepatitis C: recommendations from an AISF/SIMIT/SIMAST Expert Opinion Meeting. Dig Liver Dis 2010; 42:81-91. [PMID: 19748329 DOI: 10.1016/j.dld.2009.08.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 08/05/2009] [Indexed: 12/11/2022]
Abstract
It is increasingly clear that a tailored therapeutic approach to patients with hepatitis C virus infection is needed. Success rates in difficult to treat and low-responsive hepatitis C virus patients are not completely satisfactory, and there is the need to optimise treatment duration and intensity in patients with the highest likelihood of response. In addition, the management of special patient categories originally excluded from phase III registration trials needs to be critically re-evaluated. This article reports the recommendations for the treatment of hepatitis C virus infection on an individual basis, drafted by experts of three scientific societies.
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Bruno S, Shiffman ML, Roberts SK, Gane EJ, Messinger D, Hadziyannis SJ, Marcellin P. Efficacy and safety of peginterferon alfa-2a (40KD) plus ribavirin in hepatitis C patients with advanced fibrosis and cirrhosis. Hepatology 2010; 51:388-97. [PMID: 19918980 DOI: 10.1002/hep.23340] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED The objective of this study is to determine the efficacy and safety of peginterferon alfa-2a (40 KD)/ribavirin in patients with advanced fibrosis. Data from 341 genotype 1/4 patients (99 with bridging fibrosis/cirrhosis) treated for 48 weeks and 1547 genotype 2/3 patients (380 with bridging fibrosis/cirrhosis) treated for 16 or 24 weeks enrolled in three randomized international studies were analyzed. Sustained virological response (SVR) rates decreased progressively from 60% in genotype 1/4 patients without advanced fibrosis to 51% in those with bridging fibrosis and 33% in those with cirrhosis (trend test P = 0.0028); and from 76% to 61% and 57%, respectively, in genotype 2/3 patients treated for 24 weeks (trend test P < 0.0001). Irrespective of genotype, patients without advanced fibrosis were more likely to have an earlier response to treatment that was associated with higher SVR rates and lower relapse rates during untreated follow-up. Among patients with or without a diagnosis of advanced fibrosis, rates of SVR and relapse were similar for patients with similar responses in the first 12 weeks. CONCLUSION Compared with patients with less severe disease, SVR rates are significantly lower in patients with advanced fibrosis. However, irrespective of genotype and degree of fibrosis, the time to become hepatitis C virus (HCV) RNA undetectable was the strongest predictor of SVR.
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Toyoda H, Kumada T. Pharmacotherapy of chronic hepatitis C virus infection – the IDEAL trial: ‘2b or not 2b (= 2a), that is the question’. Expert Opin Pharmacother 2009; 10:2845-57. [DOI: 10.1517/14656560903321521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Iacobellis A, Andriulli A. Antiviral therapy in compensated and decompensated cirrhotic patients with chronic HCV infection. Expert Opin Pharmacother 2009; 10:1929-38. [DOI: 10.1517/14656560903066811] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Takemoto R, Nakamuta M, Aoyagi Y, Fujino T, Yasutake K, Koga K, Yoshimoto T, Miyahara T, Fukuizumi K, Wada Y, Takami Y, Saitsu H, Harada N, Nakashima M, Enjoji M. Validity of FibroScan values for predicting hepatic fibrosis stage in patients with chronic HCV infection. J Dig Dis 2009; 10:145-8. [PMID: 19426398 DOI: 10.1111/j.1751-2980.2009.00377.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to validate the FibroScan system compared with liver histology and serum markers for the diagnosis of hepatic fibrosis. We also tried to determine the cut-off levels and assess the feasibility of using FibroScan values to predict the fibrosis stage. METHODS In 44 patients with HCV infection, liver stiffness was evaluated by FibroScan, serum fibrosis markers and a liver biopsy. Associations between these indices were also analyzed. RESULTS FibroScan values showed a good correlation with serum levels of type IV collagen, hyaluronic acid and procollagen-III-peptide, and with the platelet count. Compared with liver histology, the FibroScan values increased proportionally with the progression of the histological fibrosis stage. Advanced fibrosis (F3 or F4) could be efficiently predicted by a FibroScan cut-off value of 15 kPa. The FibroScan sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100%, 73.9%, 77.8%, 100%, and 86.4%, respectively. CONCLUSION FibroScan values gave a good correlation with various markers of fibrosis and increased proportionally with the progression of the hepatic fibrosis stage. A FibroScan value of 15 kPa was found to be a significant separation limit for differentiating advanced fibrosis stages (F3 and F4) from the milder stages (F0-F2). FibroScan values are clinically useful for predicting the fibrosis stages and helpful in managing interferon therapy in patients with chronic hepatitis C.
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Affiliation(s)
- Ryosuke Takemoto
- Department of Gastroenterology, Kyushu Medical Center, National Hospital Organization, Fukuoka, Japan
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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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McHutchison JG, Manns MP, Brown RS, Reddy KR, Shiffman ML, Wong JB. Strategies for managing anemia in hepatitis C patients undergoing antiviral therapy. Am J Gastroenterol 2007; 102:880-9. [PMID: 17397412 DOI: 10.1111/j.1572-0241.2007.01139.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: 12/11/2022]
Abstract
Anemia is a common side effect that begins soon after the initiation of peginterferon/ribavirin in the treatment of hepatitis C virus (HCV) infection. It can cause symptoms that negatively impact quality of life (QOL) and is the most common reason for reducing the dose and temporarily or permanently discontinuing ribavirin. Such dose modifications have been shown to reduce the efficacy of treatment. Administering erythropoietin can improve anemia caused by peginterferon and ribavirin therapy and is more effective than dose reduction at improving QOL during treatment. However, erythropoietin, which is not approved by the U.S. Food and Drug Administration (FDA) for use in patients with HCV infection, adds another parenteral drug to the patient's treatment regimen, and is associated with additional costs, inconvenience, and potential side effects. A new ribavirin analog, viramidine, is expected to be associated with a lower incidence of anemia and, if proven effective, may eventually be substituted for ribavirin in combination with peginterferon to treat chronic hepatitis C. In the meantime, physicians must make the best possible use of the available options for managing anemia, especially in select patient groups who are most at risk for anemia and its complications.
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Affiliation(s)
- John G McHutchison
- Duke Clinical Research Institute, Division of Gastroenterology Duke University, Durham, North Carolina 27705, USA
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Moucari R, Ripault MP, Oulès V, Martinot-Peignoux M, Asselah T, Boyer N, El Ray A, Cazals-Hatem D, Vidaud D, Valla D, Bourlière M, Marcellin P. High predictive value of early viral kinetics in retreatment with peginterferon and ribavirin of chronic hepatitis C patients non-responders to standard combination therapy. J Hepatol 2007; 46:596-604. [PMID: 17218037 DOI: 10.1016/j.jhep.2006.10.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 09/25/2006] [Accepted: 10/24/2006] [Indexed: 01/16/2023]
Abstract
BACKGROUND/AIMS To evaluate the efficacy of peginterferon alfa-2b and ribavirin in unselected consecutive patients with chronic hepatitis C, treated outside of trials, who were relapsers or non-responders to interferon and ribavirin combination. METHODS One hundred and fifty-four patients were evaluated. There were 101 non-responders and 53 relapsers to standard combination therapy. Patients were retreated with peginterferon alfa-2b 1.5 microg/kg/wk plus ribavirin 1000-1200 mg/day during 48 weeks. RESULTS Forty-four patients (28.6%) achieved sustained virological response (SVR). Rapid (week 4) and early (week 12) virological response had high negative predictive values of SVR (94% and 97%, respectively); however positive predictive values were relatively low (52% and 49%, respectively). Relapsers had higher SVR rates (58.5%) than non-responders (13%) p<0.0001. In non-responders, SVR raised to 50% in patients with genotype non-1 and mild or moderate fibrosis. In multivariate analysis, predictors of SVR were: relapse after interferon plus ribavirin combination, mild or moderate fibrosis, genotype non-1 and baseline viral load <2 million copies/ml. CONCLUSIONS Relapsers to interferon plus ribavirin therapy, and non-responders with genotype non-1 and mild or moderate fibrosis, achieved a relatively high SVR rate following retreatment with peginterferon plus ribavirin. Early viral kinetics had a high negative predictive value of SVR.
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Affiliation(s)
- Rami Moucari
- Service d'Hépatologie and INSERM CRB3, Hôpital Beaujon, AP-HP, Université Paris VII, Clichy, France
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Fargion S, Borzio M, Maraschi A, Cargnel A. Triple antiviral therapy in HCV positive patients who failed prior combination therapy. World J Gastroenterol 2006; 12:5293-300. [PMID: 16981257 PMCID: PMC4088194 DOI: 10.3748/wjg.v12.i33.5293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the efficacy of triple therapy (peginte-rferon or high dose standard interferon, plus ribavirin and amantadine) in nonresponders to prior combination therapy.
METHODS: A total of 196 patients were enrolled in a multicenter, open, randomized study. Patients were given 180 μg/wk of peginterferon-alpha-2a (40 kDa) plus ribavirin (800-1000 mg/d) and amantadine (200 mg/d) for 48 wk (group A) or interferon-alpha-2a (6 MU/d for 4 wk, 3 MU/d for 20 wk, and 3 MU tiw for 24 wk) plus ribavirin (800-1000 mg/d) and amantadine (200 mg/d) for 48 wk (group B).
RESULTS: Overall sustained virologic response (SVR) was 26.6% (32.1% and 19.5% in group A and B, P = 0.057). Baseline ALT >120 UI/L (OR 2.4; 95% CI:1.11 to 5.20; P = 0.026) and HCV RNA negativity after 12 wk (OR 8.7; 95% CI: 3.87 to 19.74; P < 0.0001) were independently associated with SVR. Therapy discontinuation occurred less frequently in patients treated with peginterferon than standard interferon (P = 0.036).
CONCLUSION: More than 25% of nonresponders to combination therapy can eradicate HCV infection when retreated with triple therapy, especially if they have a high baseline ALT and are treated with pegylated interferon.
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Affiliation(s)
- Silvia Fargion
- Fondazione Policlinico Mangiagalli e Regina Elena, Dipartimento di Medicina Interna Pad. Granelli, via F. Sforza 35, Milano 20121, Italy.
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Weitzman G, Jacobson I. Peginterferon α-2b in the treatment of hepatitis C. Future Virol 2006. [DOI: 10.2217/17460794.1.3.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hepatitis C virus (HCV) is a leading public health problem affecting as many as 4 million Americans. Chronic HCV infection can progress to hepatocellular carcinoma, cirrhosis and death. Interferon-α-based therapies, initially as monotherapy and later in combination with ribavirin, have proven effective in the treatment of HCV infection, but standard interferon is hampered pharmacokinetically by a short half life. With the advent of the pegylated-interferons, administered in combination with oral ribavirin, the chances for HCV eradication have improved further. Peginterferon α-2b, the formuation discussed in this review, provides greater antiviral pressure while maintaining a tolerable side-effect profile with more convenient once-weekly dosing. Clinical trials have focused on treatment-naïve patients as well as on many different HCV subpopulations, including difficult-to-treat patients such as previous interferon therapy failures and patients with HCV cirrhosis.
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Affiliation(s)
- Gil Weitzman
- Weill Medical College of Cornell University, 1300 York Avenue, F-231, New York, NY 10021, USA
| | - Ira Jacobson
- Weill Medical College of Cornell University, 450 E. 69th Street, New York, NY 10021, USA
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