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.
|
