Naltrexone
is a pharmaceutical drug,also referred to by its brand name, ReVia
Many
physicians have been reluctant to treat active or recent injection
drug users (IDUs) with chronic hepatitis C, requiring that individuals abstain
from drugs completely for several months before initiating therapy.
Studies
have shown, however, that regular or sporadic drug users can be successfully treated
with interferon-based therapy if they
can maintain good adherence, and
current guidelines say that drug users as a group should not be automatically
denied treatment.
As
reported in the January 2007 issue of Hepatology, researchers conducted
a study of chronic hepatitis C patients treated at a community-based drug rehabilitation
clinic in Australia between October 2002 and March 2005.
Participants
received subcutaneous implants that release naltrexone, an opiate antagonist that
blocks the effects of narcotics such as heroin, thereby reducing the likelihood
of relapsing to drug use. (Note: naltrexone implants are not yet approved by the
U.S. Food and Drug Administration.)
Hepatitis
C patients were treated with interferon plus
ribavirin, and data from the first 50 subjects to complete a course of therapy
plus 6 months follow-up were prospectively analyzed.
Results
•
34 out of 50 patients (68%) achieved and end-of-treatment
response, defined as undetectable HCV RNA.
•
Viral eradication was maintained in the 22 patients with 12 or more months of
post-treatment follow-up.
•
11 patients (22%) stopped treatment, prematurely due to side effects or poor adherence.
•
46% of patients received antidepressants
and/or antipsychotic medications during treatment.
•
17 out of the 31 patients
who achieved SVR at 6 months reported no further injection drug use.
•
13 of the 31 reported
occasional injection drug use during anti-HCV therapy and after completion of
treatment.
•
2 individuals with
an end-of-treatment response were likely re-infected due to unsafe injection practices.
•
1 of these patients
was re-treated and achieved SVR.
Conclusion
"This
study of HCV treatment in a community-based subcutaneous naltrexone implant clinic
found antiviral therapy resulted in a 62% SVR," the authors concluded. "This
result is comparable to that reported in hospital-based clinics in non-IDU patients.
The side effect profile and compliance was also similar." They recommended
that, "HCV antiviral therapy should be offered to this large and currently
under-treated group."
1/19/07
Reference G
P Jeffrey, G Macquillan, F Chua, and others. Hepatitis C virus eradication in
intravenous drug users maintained with subcutaneous naltrexone implants. Hepatology
45(1): 111-117. January 2007.
