Selected Hepatitis C Patients with Decompensated Cirrhosis Can Benefit from Interferon-based Therapy prior to Liver Transplantation
Selected Hepatitis C Patients with Decompensated Cirrhosis Can Benefit from
Interferon-based Therapy prior to Liver Transplantation
By Liz Highleyman
Many clinicians are reluctant to use interferon-based therapy to treat chronic
hepatitis C patients with decompensated cirrhosis (liver failure) due to the
risk of severe adverse events. Such patients, however, may be in the most dire
need of treatment as they await liver transplantation.
As reported at the Digestive Disease Week 2008 conference last month in San
Diego, Alexandra Retana and John Wong performed a systemic review of prior
studies looking at the risks and benefits of antiviral therapy for decompensated
hepatitis C patients.
The researchers searched the Medline and Web of Science databases for entries
published between 1990 and 2007 using the subject headings "hepatitis C,"
"cirrhosis," "antiviral agents," "preoperative management," and "adverse
effects." They also looked at bibliographies of related articles.
The analysis included randomized controlled trials, observational case control
studies, and cohort studies involving hepatitis C patients on transplant waiting
lists with at least 1 episode of decompensation or signs of decompensated
cirrhosis (for example, bleeding esophageal varices or ascites).
Results
. The investigators identified 4 cohort studies and 1 case control study
with 255 patients (70% men, mean age 62 years; average Child-Pugh score
7.4-11.9).
. Patients were treated with either:
. Conventional interferon monotherapy (1-5 MU daily or 1.5-3 MU thrice
weekly);
. Conventional interferon plus ribavirin (3 MU daily and 400-800
mg/day, respectively);
. Pegylated interferon monotherapy (0.5 mcg/kg/week);
. Pegylated interferon plus ribavirin (1 mcg/kg/week and 600-800
mg/day, respectively).
. Patients were treated either for 24-48 weeks or until transplantation.
. The overall end-of-treatment response rate was 45% and the overall
sustained virological response (SVR) rate was 23%.
. The overall relapse rate was 52%.
. Among patients who had undetectable HCV RNA by PCR at the time of
transplantation, the recurrence rate was 39%.
. The most commonly reported adverse effects were leukopenia or
neutropenia (low white blood cell count) at 46%, thrombocytopenia (low platelet
count) at 38%, and anemia (low hemoglobin and/or red blood cell count) at 35%.
. The treatment-related mortality rate was 3.8%.
. 30% of patients required dose reductions due to adverse effects and 24%
discontinued treatment.
. In the study with an untreated control arm, control subjects had a
higher adverse event rate (88% vs 59%) and a higher mortality rate (32% vs 16%,
all in patients without SVR).
Based on these findings, the researchers concluded that "antiviral therapy in
carefully selected patients with advanced cirrhosis may be attempted and
potentially beneficial, but is likely to be associated with frequent adverse
effects."
6/10/08
Reference
AK Retana and JB Wong. Pre-transplant antiviral treatment of hepatitis C with
decompensated cirrhosis: a systematic review of risks and benefits. Digestive
Disease Week (DDW) 2008. San Diego, CA. May 17-22, 2008. Abstract S1011.
http://www.hivandhepatitis.com/2008icr/ddw/docs/061008_a.html