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El Kassas M, Alboraie M, Naguib M, Omar H, Tahan AE, Moaz I, Abdellah M, Ezzat S, Wifi MN, Sherief AF, Eltabbakh M, Abdelsalam L, Eissa AH, Omran D. A significant upsurge of body mass index in patients with chronic hepatitis C successfully treated with direct-acting antiviral regimens. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:708-713. [PMID: 31418415 DOI: 10.5152/tjg.2019.18514] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS There is less data regarding the changes in body mass index (BMI) after treating hepatitis C virus (HCV) patients with new direct-acting antiviral agents (DAAs). This study aimed to assess the changes in BMI in chronic HCV patients treated with DAAs in Egypt and to explore other factors influencing this change. MATERIALS AND METHODS The data of chronic HCV patients who received antiviral therapy with new DAAs in one of Egypt's specialized viral hepatitis treatment centers were retrospectively analyzed. In addition to the routine clinical and laboratory workup, changes in body weight during and after treatment were monitored and BMI was calculated. Viral load was measured at 12 weeks post-treatment to assess a sustained virological response. Patients with documented thyroid abnormalities, bariatric surgery, or ensuing special diets were excluded. BMI of >30 was taken as the cutoff for pa¬tients with obesity. RESULTS The study included 162 patients with a mean age of 48.56±11.49 years, of whom 61.1% were males, 16% were treatment-experienced, 12% were diabetic, and 29% were obese. Treatment duration was 12 weeks in 84% of patients and 24 weeks in 16% of patients. There was a significant increase in BMI post-treatment as compared to pretreatment measures (28.68±5.35 vs 28.18±4.55) (p=0.03). BMI changes were constant regardless of cirrhosis or previous treatment experience. CONCLUSION Treatment of chronic HCV with DAAs was associated with increased body mass index. Further studies are needed to explore if this effect is secondary to treatment with DAAs or is an improvement in the liver function and lifestyle of treated patients.
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Affiliation(s)
- Mohamed El Kassas
- Endemic Medicine Department, Helwan University School of Medicine, Cairo, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine and and Hepatogastroenterology Unit, Al-Azhar University, Cairo, Egypt
| | - Mervat Naguib
- Internal Medicine Department, Cairo University School of Medicine, Cairo, Egypt
| | - Heba Omar
- Endemic Medicine and Hepato-Gastroenterology Department, Cairo University School of Medicine, Cairo, Egypt
| | - Adel El Tahan
- New Cairo Viral Hepatitis Treatment Unit, Cairo, Egypt
| | - Inas Moaz
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Shebin Elkom, Egypt
| | - Mohamed Abdellah
- Department of Internal Medicine and and Hepatogastroenterology Unit, Al-Azhar University, Cairo, Egypt
| | - Sameera Ezzat
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Shebin Elkom, Egypt
| | - Mohamed-Naguib Wifi
- Internal Medicine Department, Cairo University School of Medicine, Cairo, Egypt
| | - Ahmed F Sherief
- Tropical Medicine Department, Ain Shams University School of Medicine, Cairo, Egypt
| | - Mohamed Eltabbakh
- Tropical Medicine Department, Ain Shams University School of Medicine, Cairo, Egypt
| | - Lobna Abdelsalam
- Department of Clinical - Chemical Pathology, Cairo University School of Medicine, Cairo, Egypt
| | - Amal H Eissa
- Clinical Pathology Department, Helwan University School of Medicine, Cairo, Egypt
| | - Dalia Omran
- Endemic Medicine and Hepato-Gastroenterology Department, Cairo University School of Medicine, Cairo, Egypt
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Casey KA, Guo X, Smith MA, Wang S, Sinibaldi D, Sanjuan MA, Wang L, Illei GG, White WI. Type I interferon receptor blockade with anifrolumab corrects innate and adaptive immune perturbations of SLE. Lupus Sci Med 2018; 5:e000286. [PMID: 30538817 PMCID: PMC6257383 DOI: 10.1136/lupus-2018-000286] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/14/2018] [Accepted: 09/28/2018] [Indexed: 11/04/2022]
Abstract
Objective Anifrolumab is a fully human immunoglobulin G1 κ monoclonal antibody specific for subunit 1 of the type I interferon (IFN) α receptor. In a phase IIb study of adults with moderate to severe SLE, anifrolumab treatment demonstrated substantial reductions in multiple clinical endpoints. Here, we evaluated serum proteins and immune cells associated with SLE pathogenesis, type I interferon gene signature (IFNGS) test status and disease activity, and how anifrolumab affected these components. Methods Whole blood samples were collected from patients enrolled in MUSE (NCT01438489) for serum protein and cellular assessments at baseline and subsequent time points. Data were parsed by IFNGS test status (high/low) and disease activity. Protein expression and immune cell subsets were measured using multiplex immunoassay and flow cytometry, respectively. Blood samples from healthy donors were analysed for comparison. Results Baseline protein expression differed between patients with SLE and healthy donors, IFNGS test-high and -low patients, and patients with moderate and severe disease. Anifrolumab treatment lowered concentrations of IFN-induced chemokines associated with B, T and other immune cell migration in addition to proteins associated with endothelial activation that were dysregulated at baseline. IFNGS test-high patients and those with high disease activity were characterised by low baseline numbers of lymphocytes, circulating memory T-cell subsets and neutrophils. Anifrolumab treatment reversed lymphopenia and neutropenia in the total population, and normalised multiple T-cell subset counts in IFNGS test-high patients compared with placebo. Conclusions Anifrolumab treatment reversed IFN-associated changes at the protein and cellular level, indicating multiple modes of activity. Trial registration number NCT01438489.
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Affiliation(s)
- Kerry A Casey
- Respiratory, Inflammation and Autoimmunity, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Xiang Guo
- Translational Sciences, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Michael A Smith
- Respiratory, Inflammation and Autoimmunity, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Shiliang Wang
- Translational Sciences, MedImmune LLC, Gaithersburg, Maryland, USA
| | | | - Miguel A Sanjuan
- Respiratory, Inflammation and Autoimmunity, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Liangwei Wang
- Biostatistics, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Gabor G Illei
- Clinical Development, MedImmune LLC, Gaithersburg, Maryland, USA
| | - Wendy I White
- Research Bioinformatics, MedImmune LLC, Gaithersburg, Maryland, USA
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Sofosbuvir Based Regimens in the Treatment of Chronic Hepatitis C with Compensated Liver Cirrhosis in Community Care Setting. Int J Hepatol 2018; 2018:4136253. [PMID: 30155312 PMCID: PMC6093047 DOI: 10.1155/2018/4136253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/19/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Direct-acting antiviral (DAA) drugs have been highly effective in the treatment of chronic hepatitis C (CHC) infection. We aim to evaluate the treatment response of Sofosbuvir based DAA in CHC patients with compensated liver cirrhosis as limited data exists in the real-world community setting. METHODS All the CHC patients with compensated liver cirrhosis treated with Sofosbuvir based DAAs between January 2014 and December 2017 in a community clinic setting were retrospectively analyzed. Pretreatment baseline patient characteristics, treatment efficacy with the sustained virologic response at 12 weeks posttreatment (SVR12), and adverse reactions were assessed. RESULTS One hundred and twelve patients with CHC infection and concurrent compensated cirrhosis were included in the study. Black patients represented the majority of the study population (64%). Eighty-seven patients were treated with Ledipasvir/Sofosbuvir (LDV/SOF) ±Ribavirin and 25 patients were treated with Sofosbuvir/Velpatasvir (SOF/VEL). Overall, SVR 12 after treatment was achieved in 90% in patients who received one of the two DAA regimens (89.7% in LDV/SOF group and 92% in SOF/VEL group). SVR 12 did not vary based on age, sex, body mass index, baseline HCV viral load, HCV/HIV coinfection, type of genotype, and prior treatment status. Apart from a low platelet count, there were no other factors associated with a statistical difference in SVR 12(p=0.002) between the two regimens. Fatigue (35%) was the most common adverse effect and no patients discontinued treatment due to adverse effects. CONCLUSION In the community care setting, Sofosbuvir based DAAs are safe, effective with high overall SVR, and well tolerated in patients with CHC patients with compensated liver cirrhosis.
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Almasry SM, Hassan ZA, Elsaed WM, Elbastawisy YM. Structural evaluation of the peritubular sheath of rat's testes after administration of ribavirin: A possible impact on the testicular function. Int J Immunopathol Pharmacol 2017; 30:282-296. [PMID: 28799438 PMCID: PMC5815259 DOI: 10.1177/0394632017726261] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Effects of ribavirin on the structure of peritubular sheath (PS) of seminiferous tubules and on testicular functions were studied. We found that ribavirin at a dose of 4 mg/kg/day for 4 weeks produced a significant reduction in testosterone level (6.3 ± 0.2; P < 0.001) and in spermatogenic score count (3.8 ± 0.2; P < 0.001) compared to control values. The thickness of PS (17.8 ± 1.13) and tubular lumen perimeter (1024.7 ± 67) was significantly increased compared to controls (10.7 ± 0.70; P < 0.001 and 808 ± 25; P = 0.004, respectively). The length of germinal epithelium (411.8 ± 39) and tubular external diameters (1661.8 ± 115) was significantly reduced compared to control values (708.4 ± 40; P < 0.001 and 2358.8 ± 169; P < 0.001, respectively). The basement membranes (BMs) were thickened with great deposition of collagen. Myoid cells showed altered structure and extracellular matrix revealed disorganization by excessive collagen I and IV accumulation. Testicular damage was established histologically. Evidence of apoptosis was detected in germ cells. There was a significant increase in integrated density of Casp-3 expression (38,121,743 ± 1,763,420; P < 0.001) in seminiferous tubules compared to control (24,788,409 ± 1,900,140). It is concluded that ribavirin can cause alterations of the testicular function and structure with increased apoptosis in the tissues after 4 weeks of administration. The damaging effect could be persuaded by destruction of the peritubular sheath.
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Affiliation(s)
- Shaima M Almasry
- 1 Department of Anatomy and Embryology, Taibah University, Medina, Saudi Arabia.,2 Department of Anatomy and Embryology, Mansoura University, Mansoura, Egypt
| | - Zeinab A Hassan
- 1 Department of Anatomy and Embryology, Taibah University, Medina, Saudi Arabia.,3 Department of Histology and Cell Biology, Zagazig University, Zagazig, Egypt
| | - Wael M Elsaed
- 1 Department of Anatomy and Embryology, Taibah University, Medina, Saudi Arabia.,2 Department of Anatomy and Embryology, Mansoura University, Mansoura, Egypt
| | - Yasser M Elbastawisy
- 1 Department of Anatomy and Embryology, Taibah University, Medina, Saudi Arabia.,2 Department of Anatomy and Embryology, Mansoura University, Mansoura, Egypt
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The prevalence and impact of thrombocytopenia, anaemia and leucopenia on sustained virological response in patients receiving hepatitis C therapy: evidence from a large 'real world' cohort. Eur J Gastroenterol Hepatol 2016; 28:398-404. [PMID: 26695428 DOI: 10.1097/meg.0000000000000556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of the study was to explore the extent of thrombocytopenia (TCP), anaemia and leucopenia in patients with hepatitis C and evaluate how they impact the management of antiviral therapy, the attainment of sustained virological response (SVR), and some therapy-related adverse events. MATERIALS AND METHODS The Scottish Hepatitis C Clinical Database was used in this retrospective study. The prevalence of TCP, anaemia and leucopenia was evaluated. The impact of the three deficiencies on antiviral therapy management, serious adverse events and SVR attainment was assessed in patients who received therapy. RESULTS The prevalence of TCP, anaemia and leucopenia was 18.5, 0.9 and 0.2% among 4907 treated patients at baseline, increasing to 72, 25.8 and 5.4% during treatment, respectively. Dose reduction occurred in 29.3% of the patients without TCP; this percentage was higher in those with baseline TCP (53%) and in those who acquired it during treatment (35%). Similar results were found for anaemia and leucopenia. Baseline TCP (odds ratio=0.67, P<0.001) and baseline anaemia (odds ratio=0.43, P=0.03) were identified as risk factors associated with lower SVR rate; acquired TCP and anaemia were not associated with reduced SVR. CONCLUSION Baseline TCP or anaemia increased the risk of dose cessation. Patients who acquired TCP, anaemia or leucopenia during treatment did not exhibit compromised SVR rates, whereas patients with TCP or anaemia at baseline did. The potential benefit of growth factors in maintaining SVR rate is likely to be confined to those with baseline TCP or anaemia rather than to those who acquire it during therapy, where dose reduction does not appear to reduce the chance of SVR.
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Alwakeel HR, Zaghla HE, Omar NA, Alashinnawy HA, Rewisha EA, Matarese LE, Taha AA, Kandil HM. Spontaneous weight change during chronic hepatitis C treatment: association with virologic response rates. Int J Med Sci 2013; 10:1830-6. [PMID: 24324359 PMCID: PMC3856373 DOI: 10.7150/ijms.6184] [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: 03/04/2013] [Accepted: 05/28/2013] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We examined weight changes during chronic hepatitis C (CHC) therapy and association with virologic response. METHODS Weight changes were compared between subjects achieving rapid, early, and sustained virologic response rates (RVR, EVR, and SVR). RVR, EVR and SVR were compared among patients with or without weight loss of ≥ 0.5 body mass index (BMI) units (kg/m²) at 4, 12, 48 weeks. RESULTS CHC therapy was initiated in 184 cases. Median pretreatment BMI was 27.7 (18.4-51.3) with 38% overweight and 31% obese (BMI ≥25 and ≥ 30, respectively). Among patients with liver biopsies (n = 90), steatosis was present in 31.6%; fibrosis grade of 1-2/6 in 46%, 3-4 in 37.3% and 5-6 in 14.7%. Mean weight loss at 4, 12, 24 and 48 weeks of therapy were 1.2, 2.6, 3.8 and 3.3 kg, respectively. After 4 and 12 weeks of treatment, 38% and 54.3% had a BMI decrement of ≥ 0.5 kg/m². For genotype 1, weight loss at 4 weeks was associated with significantly higher EVR (90.0% vs. 70%, p = 0.01) and a tendency towards better RVR and SVR (42.9% vs. 26.0% and 55.2% vs. 34.8%, respectively, p = 0.08). In multivariate analysis, weight loss at 4 weeks was independently associated with EVR (OR 6.3, p = 0.02) but was not significantly associated with RVR or SVR. CONCLUSIONS Spontaneous weight loss at 4 and 12 weeks of CHC therapy was associated with improved EVR. Weight loss at 4 weeks was an independent predictor of EVR but not SVR.
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Affiliation(s)
- Hany R Alwakeel
- 1. Hepatology Department, National Liver Institute, Monufia University, Shibin Alkom, Egypt
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Mohammadi B, Yaghobi R, Dehghani M, Behzad Behbahani A. The molecular prevalence of viral infections in transplant candidates with bone marrow suppression, shiraz, southern iran, 2010. Int J Organ Transplant Med 2013; 4:87-94. [PMID: 25013658 PMCID: PMC4089309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Transient bone marrow suppression, characterized by acute inability of the bone marrow to produce circulating blood cells, may strongly relate to the pathogenesis of some viral infections. OBJECTIVE To study the prevalence of some DNA and RNA viruses in patients with transient bone marrow suppression. METHODS EDTA-treated blood samples were collected from 27 patients with clinically- and laboratory-confirmed transient bone marrow suppression. The genomic DNA of hepatitis B virus, adenovirus, polyomavirus BK, and parvovirus B19, and genomic RNA of hepatitis C and G viruses were extracted and amplified by sensitive and specific in-house simple and nested PCR and RT-PCR protocols, respectively. The risk factors that might be related to the studied viral infections were analyzed. RESULTS Hepatitis B virus infection was diagnosed in 9 (33%) of 27 patients; adenovirus infection in 2 (7%); and parvovirus B19 infection in 7 (26%) of 27 patients. The genomic DNA of polyomovirus BK was not detected in any patients. Both hepatitis C and G viruses were found in 3 (11%) of 27 patients. CONCLUSION Diagnosis of the high prevalence of hepatitis B virus, and parvovirus B19 in patients with transient bone marrow suppression, reflects the importance of these viral infections in introducing bone marrow suppression. This hypothesis should be confirmed in further studies.
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Affiliation(s)
- B. Mohammadi
- Shiraz Transplant Research Center, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - R. Yaghobi
- Shiraz Transplant Research Center, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran , Correspondence: Ramin Yaghobi, PhD, Shiraz Transplant Research Center, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-711-647-6331, Fax: +98-711-647-6331, E-mail:
| | - M. Dehghani
- Hematology Research Center and Bone marrow Transplant Unit, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A. Behzad Behbahani
- School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Namazee N, Sali S, Asadi S, Shafiei M, Behnava B, Alavian SM. Real response to therapy in chronic hepatitis C virus patients: a study from iran. HEPATITIS MONTHLY 2012; 12:e6151. [PMID: 23087759 PMCID: PMC3475060 DOI: 10.5812/hepatmon.6151] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 06/26/2012] [Accepted: 07/06/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite significant advances in the treatment of chronic hepatitis C in the past decades, factors which can affect response rates to combination therapy; peginterferon and ribavirin, are still under study and reaching sustained virological response (SVR) is affected by several different factors. OBJECTIVES To investigate predictor factors contributing to SVR in Iranian patients. PATIENTS AND METHODS The present non-randomized, clinical trial was conducted on 100 patients referred to the Tehran Hepatitis Center in 2009-2011. The patients were administered combined peginterferon α-2a-ribavirin treatment, based on the standard protocol of the Iranian Ministry of Health. At the end of the treatment, the SVR rate and predictors were evaluated. RESULTS The mean age of the patients was 42 and 78% were male. Genotype 1a was the most common (70%) and 55% of patients were treatment naïve. The outcomes showed that 12%, 16% and 22% patients were; non-responders, breakthroughs and relapsers, respectively, while 50% of the patients reached SVR. Patients reaching SVR were aged 40 years or lower, they were less likely to have been a non-responder in prior treatments, more likely to have a non-1a genotype and a higher number had an HCV RNA of less than 600 000 IU/ml. The multivariate analysis showed that an age of 40 or lower (OR = 3.74, CI95% = 1.52-9.22), a non-1a genotype (OR = 3.71, CI 95% = 1.40-9.81) and an HCV RNA less than 600 000 IU/ml (OR = 2.52, CI 95% = 1.03-6.15) may be useful SVR predictors. CONCLUSIONS The findings of the present study showed that half of the patients reached SVR through combined peginterferon α-2a and ribavirin treatment, the majority of whom had genotype 3a and a minority had genotype 1a. In addition, an age of 40 or lower, non-1a genotype and a viral load less than 600 000 IU/ml were strong SVR predictors.
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Affiliation(s)
- Najmeh Namazee
- Infectious Disease and Tropical Medicine Research Center, Shahid Beheshti University of Sciences, Tehran, IR Iran
| | - Shahnaz Sali
- Infectious Disease and Tropical Medicine Research Center, Shahid Beheshti University of Sciences, Tehran, IR Iran
| | - Sorour Asadi
- Infectious Disease and Tropical Medicine Research Center, Shahid Beheshti University of Sciences, Tehran, IR Iran
| | - Mostafa Shafiei
- Research Center for Gastroenterology and Liver Diseases, Baqiatallah University of Sciences, Tehran, IR Iran
| | - Bita Behnava
- Research Center for Gastroenterology and Liver Diseases, Baqiatallah University of Sciences, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Research Center for Gastroenterology and Liver Diseases, Baqiatallah University of Sciences, Tehran, IR Iran
- Corresponding author: Seyed Moayed Alavian, Research Center For Gastroenterology and Liver Diseases, Baqiatallah University of Sciences, Mollasadra St., Vanak Sq., P. O. Box: 141553651, Tehran, IR Iran. Tel.: +98-2188067114, Fax: +98-2188945188, E-mail:
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Marcellin P, Roberts SK, Reddy KR, Harrison SA, Jensen DM, Hadziyannis S, Diago M, Weltman M, Messinger D, Tatsch F, Rizzetto M. Safety profile of standard- vs. high-dose peginterferon alfa-2a plus standard-dose ribavirin in HCV genotype 1/4 patients: pooled analysis from 5 randomized studies. Expert Opin Drug Saf 2012; 11:901-9. [PMID: 22943161 DOI: 10.1517/14740338.2012.721927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This analysis examines the safety profile of standard- versus high-dose peginterferon alfa-2a. METHODS Data were pooled from five trials including HCV genotype 1- or 4-infected naive and treatment-experienced patients (n = 2,940). Patients were randomized to receive peginterferon alfa-2a at 180 μg/week (standard-dose; n = 1,672) or 360 μg/week (high-dose; n = 1,268) plus ribavirin 1,000/1,200 mg/day for 12 weeks; after 12 weeks, all received standard dose. This safety analysis was restricted to the first 12 weeks. RESULTS In standard and high-dose groups, similar frequencies of serious adverse events (SAEs, 3.2 and 4.2%, respectively) and treatment discontinuations for safety reasons (2.8 and 2.9%) were reported. More patients reported weight decrease as an adverse event (AE) in the 360 μg/week group (7.7 vs. 3.3%). Significant (p < 0.05) independent predictors for discontinuation due to safety were older age, male gender, lower albumin and low neutrophil count, but not the starting dose of peginterferon alfa-2a. Although more laboratory abnormalities were reported in patients receiving high-dose peginterferon alfa-2a, this was not reflected in AEs or discontinuations, suggesting these are adequately managed by dose modification. CONCLUSIONS High-dose peginterferon alfa-2a for 12 weeks does not significantly increase the incidence of SAEs or discontinuations for safety reasons, beyond that of a standard dose regimen.
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Affiliation(s)
- Patrick Marcellin
- Hôpital Beaujon, 100 Boulevard Du General Leclerc, Clichy, 92110, France.
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Sustained Viral Response and Hematological Adverse Events in Children With Chronic Hepatitis C. HEPATITIS MONTHLY 2012. [DOI: 10.5812/hepatmon.5127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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11
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Vigano A, Manfredini V, Zuccotti GV. Sustained viral response and hematological adverse events in children with chronic hepatitis C. HEPATITIS MONTHLY 2012; 12:211-2. [PMID: 22550531 PMCID: PMC3339423 DOI: 10.5812/hepatmon.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 02/26/2012] [Accepted: 03/02/2012] [Indexed: 12/11/2022]
Affiliation(s)
- Alessandra Vigano
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Corresponding author: Alessandra Vigano, Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy. Tel.: +02-39042253, Fax: +2-39042254, E-mail:
| | - Valeria Manfredini
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy
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El-Shabrawi M, El-Shabrawi M, Isa M, Isa M. Sustained Viral Response and Hematological Adverse Events During Chronic Hepatitis C Infection Treatment. HEPATITIS MONTHLY 2012; 12:122-123. [DOI: 10.5812/hepatmon.4872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
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13
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El-Shabrawi M, Isa M. Sustained viral response and hematological adverse events during chronic hepatitis C infection treatment. HEPATITIS MONTHLY 2012; 12:122-3. [PMID: 22509190 PMCID: PMC3321320 DOI: 10.5812/hepatmon.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 01/25/2012] [Accepted: 02/01/2012] [Indexed: 12/11/2022]
Affiliation(s)
- Mortada El-Shabrawi
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
- Corresponding author: Mortada Hassan El-Shabrawi, 3 Nablos St. off Shehab St. Mohandesseen, Cairo 12411, Egypt. Tel.: +20-235721790, Fax: +20-237619012, E-mail:
| | - Mona Isa
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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Fioravante M, Alegre SM, Marin DM, Lorena SLS, Pereira TS, Soares EC. Weight loss and resting energy expenditure in patients with chronic hepatitis C before and during standard treatment. Nutrition 2011; 28:630-4. [PMID: 22196981 DOI: 10.1016/j.nut.2011.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 07/30/2011] [Accepted: 08/20/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Infection with hepatitis C virus (HCV) is a serious public health problem worldwide. In clinical studies, weight loss has been reported in 11% to 29% of patients treated with pegylated interferon-α-2a/2b. Few reports have tried to explain such a weight loss. The aim of this study was to evaluate nutritional status, body composition, and resting energy expenditure (REE) in patients with chronic hepatitis C before and during treatment with pegylated interferon and ribavirin. METHODS This was a prospective study with the evaluation of patients with hepatitis C virus before and after 12 wk of treatment with pegylated interferon and ribavirin. The evaluation consisted of anthropometry (weight, height, body mass index, and waist circumference), and body composition was determined by bioelectrical impedance analysis. The REE of each individual was obtained by indirect calorimetry. To compare the two phases of treatment, the Wilcoxon test was used. The significance level was 5%. RESULTS Subjects had significant weight loss during treatment with a consequent decrease in body mass index. This weight decrease was accompanied by a significant decrease in body fat and no decrease in fat-free mass. There was a significant decrease in energy intake as assessed by 24-h recall. However, there was no change in REE and in REE corrected for fat-free mass. CONCLUSION Our study of patients with hepatitis C treatment showed that these patients had significant weight loss and this was not associated with changes in energy expenditure. However, we observed a significant decrease in energy intake, pointing to a possible need for intervention measures to decrease the damage.
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Affiliation(s)
- Milena Fioravante
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas/UNICAMP, Sao Paulo, Brazil.
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Pawlowska M, Pilarczyk M, Foksinska A, Smukalska E, Halota W. Hematological Adverse events and Sustained Viral Response in Children Undergoing Therapy for Chronic Hepatitis C Infection. HEPATITIS MONTHLY 2011. [PMID: 22368680 DOI: 10.5812/kowsar.1735143x.4223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Treatment of hepatitis C virus (HCV) infection with interferon (IFN) and ribavirin (RBV) is associated with adverse events, which may affect the patient's adherence to the treatment regimen and the treatment efficacy. OBJECTIVES The aim of this study was to assess the sustained viral response (SVR) and interdependence between the haematological characteristics (leukocyte count, platelet count, and haemoglobin levels) in patients with chronic hepatitis C (CHC) infection during treatment with IFN and RBV. PATIENTS AND METHODS We conducted a retrospective cohort study of 170 children with CHC infection who completed treatment with IFN-α and RBV. The children were divided into 2 groups: the first group (group I, n = 119) underwent a 48-week course of treatment with recombinant IFN α-2b (Intron A) at a dosage of 3 MU 3 times a week subcutaneously and RBV at a dosage of 15 mg/kg per day orally, and the second group (group II, n = 51) was administered pegylated IFN (peg-IFN)-α-2b (PegIntron) at a dosage of 1.5 μg/kg per week subcutaneously and RBV at a dosage of 15 mg/kg per day orally for 48 weeks. The dose of IFN was not adjusted but that of ribavirin was in 2 children from group II. Hematological growth factors and erythropoietin were not used. SVR was defined as undetectable serum HCV RNA 24 weeks after the end of treatment (study week 72). Serum HCV RNA was determined by performing polymerase chain reaction, and the HCV genotypes and hematological parameters were evaluated. Serum HCV RNA levels were analysed by descriptive statistics. Means and standard deviations were calculated for values collected at the baseline, on the 12th and 48th weeks during treatment, and after 24 weeks of untreated follow-up (study week 72). RESULTS Eighty-six (50%) of the 170 patients who underwent treatment achieved SVR: 62 (51%) out of 119 children from group I and 24 (47%) out of 51 from group II. The mean serum hemoglobin levels and leukocyte and platelet counts at week 12 were significantly lower than the baseline values in both responders and non-responders from both the groups (P < 0.05). In the responders in group I, the mean levels of serum hemoglobin after 24 weeks of treatment and at the end of therapy were significantly lower than the mean levels at baseline. In the group treated with peg-IFN-α-2b and RBV (group II), the mean serum hemoglobin levels at week 12 was lower in the responders than in the non-responders (P < 0.05). The decrease in the hemoglobin levels was associated with viral response. In both the responders and non-responders from both the groups, leukocyte counts decreased during treatment, and after 12 weeks, they were more significantly lower than the baseline value. The decrease was more marked in children treated with peg-IFN-α-2b + RBV (P < 0.05). After 12 weeks of treatment, the platelet count was low in children from group II who had achieved SVR. CONCLUSIONS A mild decrease in hemoglobin levels and leukocyte and platelet counts during treatment with IFN and RBV in children with CHC infection may be factors responsible for SVR induction.
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Affiliation(s)
- Malgorzata Pawlowska
- Department of Infectious Diseases and Hepatology, Collegium Medicum, n.Copernicus University, Bydgoszcz, poland
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Pawlowska M, Pilarczyk M, Foksinska A, Smukalska E, Halota W. Hematological Adverse events and Sustained Viral Response in Children Undergoing Therapy for Chronic Hepatitis C Infection. HEPATITIS MONTHLY 2011; 11:968-74. [PMID: 22368680 PMCID: PMC3282029 DOI: 10.5812/kowsar.1735143x.789] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 10/05/2011] [Accepted: 10/28/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment of hepatitis C virus (HCV) infection with interferon (IFN) and ribavirin (RBV) is associated with adverse events, which may affect the patient's adherence to the treatment regimen and the treatment efficacy. OBJECTIVES The aim of this study was to assess the sustained viral response (SVR) and interdependence between the haematological characteristics (leukocyte count, platelet count, and haemoglobin levels) in patients with chronic hepatitis C (CHC) infection during treatment with IFN and RBV. PATIENTS AND METHODS We conducted a retrospective cohort study of 170 children with CHC infection who completed treatment with IFN-α and RBV. The children were divided into 2 groups: the first group (group I, n = 119) underwent a 48-week course of treatment with recombinant IFN α-2b (Intron A) at a dosage of 3 MU 3 times a week subcutaneously and RBV at a dosage of 15 mg/kg per day orally, and the second group (group II, n = 51) was administered pegylated IFN (peg-IFN)-α-2b (PegIntron) at a dosage of 1.5 μg/kg per week subcutaneously and RBV at a dosage of 15 mg/kg per day orally for 48 weeks. The dose of IFN was not adjusted but that of ribavirin was in 2 children from group II. Hematological growth factors and erythropoietin were not used. SVR was defined as undetectable serum HCV RNA 24 weeks after the end of treatment (study week 72). Serum HCV RNA was determined by performing polymerase chain reaction, and the HCV genotypes and hematological parameters were evaluated. Serum HCV RNA levels were analysed by descriptive statistics. Means and standard deviations were calculated for values collected at the baseline, on the 12th and 48th weeks during treatment, and after 24 weeks of untreated follow-up (study week 72). RESULTS Eighty-six (50%) of the 170 patients who underwent treatment achieved SVR: 62 (51%) out of 119 children from group I and 24 (47%) out of 51 from group II. The mean serum hemoglobin levels and leukocyte and platelet counts at week 12 were significantly lower than the baseline values in both responders and non-responders from both the groups (P < 0.05). In the responders in group I, the mean levels of serum hemoglobin after 24 weeks of treatment and at the end of therapy were significantly lower than the mean levels at baseline. In the group treated with peg-IFN-α-2b and RBV (group II), the mean serum hemoglobin levels at week 12 was lower in the responders than in the non-responders (P < 0.05). The decrease in the hemoglobin levels was associated with viral response. In both the responders and non-responders from both the groups, leukocyte counts decreased during treatment, and after 12 weeks, they were more significantly lower than the baseline value. The decrease was more marked in children treated with peg-IFN-α-2b + RBV (P < 0.05). After 12 weeks of treatment, the platelet count was low in children from group II who had achieved SVR. CONCLUSIONS A mild decrease in hemoglobin levels and leukocyte and platelet counts during treatment with IFN and RBV in children with CHC infection may be factors responsible for SVR induction.
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Affiliation(s)
- Malgorzata Pawlowska
- Department of Infectious Diseases and Hepatology, Collegium Medicum, n.Copernicus University, Bydgoszcz, poland
- Corresponding author: Malgorzata Pawlowska, Department of Children Infectious Diseases and Hepatology Collegium Medicum n. Copernicus University, Floriana 12, 85-030, Bydgoszcz, poland. Tel.: +48-523255683,+48-523255605, Fax: +48-523457195, E-mail:
| | - Malgorzata Pilarczyk
- Department of Infectious Diseases and Hepatology, Collegium Medicum, n.Copernicus University, Bydgoszcz, poland
| | - Anna Foksinska
- Department of Infectious Diseases and Hepatology, Collegium Medicum, n.Copernicus University, Bydgoszcz, poland
| | - Ewa Smukalska
- Department of Infectious Diseases and Hepatology, Collegium Medicum, n.Copernicus University, Bydgoszcz, poland
| | - Waldemar Halota
- Department of Infectious Diseases and Hepatology, Collegium Medicum, n.Copernicus University, Bydgoszcz, poland
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FRANSEN VAN DE PUTTE DE, FISCHER K, POSTHOUWER D, MAUSER-BUNSCHOTEN EP. The burden of HCV treatment in patients with inherited bleeding disorders. Haemophilia 2011; 17:791-9. [DOI: 10.1111/j.1365-2516.2011.02602.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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