Sustained Response to Interferon Monotherapy Reduces Rates of Liver Cancer and Death in Patients with HCV-related Cirrhosis

Human liver tissue afflicted with cirrhosis.

While sustained suppression of HCV replication is often used as a measure of treatment success, the ultimate goal is to reduce liver disease progression and death. To date, there has been limited data on clinical outcomes among patients with HCV-related liver cirrhosis who achieve sustained response to interferon-based therapy.

In the present study, reported in the March 2007 issue of Hepatology, Italian researchers assessed the risk of liver-related complications, hepatocellular carcinoma (HCC), and liver-related mortality in patients with cirrhosis according to their response to treatment.

The researchers collected data from a retrospective database including more than 900 consecutive patients with histologically proven HCV-related cirrhosis who were treated with conventional interferon alpha monotherapy between January 1992 and December 1997. HCC was assessed by ultrasound every 6 months.

Results

• Of 920 patients, 124 (13.5%) achieved sustained virological response (SVR).

• During a mean follow-up period of 96 months, incidence rates per 100 person-years among patients who achieved SVR were:

- liver-related complications: 0;
- HCC: 0.66;
- liver-related death 0.19.

• Among patients who did not achieve SVR, the corresponding rates were:

- liver-related complications: 1.88;
- HCC: 2.10;
- liver-related death 1.44.

• Multivariate analyses showed that failure to achieve SVR was associated with a higher risk of liver-related complications, HCC (HR 2.59), and liver-related mortality (HR 6.97) compared with sustained response.

Conclusion

"[I]n patients with HCV-related, histologically proven cirrhosis, achievement of a SVR after interferon alpha therapy was associated with a reduction of liver-related mortality, lowering both the risk of complications and HCC development," the authors concluded.

However, they added that regardless of SVR achievement, "all patients should continue surveillance because the risk of occurrence of HCC was not entirely avoided."

Because liver-related complications, HCC, and liver-related death typically develop over many years, the newer standard of hepatitis C treatment -- pegylated interferon plus ribavirin -- has not been in use long enough to assess long-term clinical outcomes. However, combination therapy produces significantly higher SVR rates than conventional interferon monotherapy, and therefore may be expected to reduce rates of liver-related complications and death by an even greater degree.

03/27/07

Reference
S Bruno, T Stroffolini, M Colombo, and others. Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: a retrospective study. Hepatology 45(3): 579-587. March 2007.