Chronic hepatitis C and interferon alpha: conventional and cumulative meta-analyses of randomized controlled trials

Cammà, Calogero; Pinzello, G.; Morabito, Alberto; Verderio, Paolo; Pagliaro, Luigi

doi:10.1016/s0002-9270(98)00800-4

Cited by 39 publications

(25 citation statements)

References 110 publications

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“…In patients with chronic hepatitis C and (PEG-)IFN-induced SVR, late relapse is rare (Tables 2 and 3). 55,56 Similar results have been obtained for patients with IFN-induced SVR after acute hepatitis C infection. 57 Generally, these patients are considered to be cured, whereas the clinical significance of residual detec- tion of HCV RNA fragments in various compartments remains unclear.…”

Section: Disease Of Unknown Originsupporting

confidence: 73%

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Occult hepatitis C: How convincing are the current data? #

Welker

Zeuzem

2009

Hepatology

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Section: Disease Of Unknown Originsupporting

confidence: 73%

“…55,56 It is actually unknown how many of these patients with reported late relapse have "true" relapse and how many were reinfected. SVR has been linked with constant improvement of quality of life, 111,112 histological improvement, 48,113 decreased risk of development of liver cancer, 114,115 and reduced liver-related mortality.…”

Section: Discussionmentioning

confidence: 99%

Occult hepatitis C: How convincing are the current data? #

Welker

Zeuzem

2009

Hepatology

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“…1 Although a complete end-of-treatment response (ETR) is obtained in about 50% of patients, half of them will relapse with a reappearance of viremia and liver necroinflammation soon after stopping therapy. Therefore, relapse remains a major issue in the long-term management of the disease.…”

Section: Relapse After Interferon (Ifn) Therapy For Chronic Hepatitismentioning

confidence: 99%

Chronic hepatitis C: Interferon retreatment of relapsers. A meta-analysis of individual patient data

et al. 1999

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Relapse after interferon (IFN) therapy for chronic hepatitis C virus (HCV) infection occurs in 50% of patients after the initial response. The benefit of retreatment with IFN alone has not been assessed in large controlled studies. To assess the effectiveness and the tolerability of IFN retreatment and to identify the optimal second course regimen, we performed a meta-analysis of individual patient's data on a set of 549 patients (mean age 43.8 years; 12.2 SD, men: 65%) who had an end-of-treatment biochemical response to a first IFN course and then relapsed. Retreatment was started within 24 months after the end of the first course. In chronic hepatitis C, the goal of treatment, defined as complete sustained response (SR) (normal alanine transaminase levels and undetectable serum hepatitis C virus-RNA (HCV-RNA) levels 6 to 12 months after therapy) is achieved in less than 20% of patients with standard interferon (IFN)-alfa schedule. 1 Although a complete end-of-treatment response (ETR) is obtained in about 50% of patients, half of them will relapse with a reappearance of viremia and liver necroinflammation soon after stopping therapy. Therefore, relapse remains a major issue in the long-term management of the disease. Several studies of retreatment with IFN alone in patients who had an ETR but subsequently relapsed after stopping IFN have been published. The results of these studies are inconclusive or conflicting because of the relatively small samples and the difficulty of generalizing patients owing to the differences in patient characteristics, study design, regimens, and types of IFN administered. Although the conclusions of the National Institutes of Health Consensus Development Conference for the retreatment of relapse of chronic hepatitis C have recently been published, 22 important questions still remain unanswered. Is monotherapy retreatment useful in relapsers? Are there any differences in the effectiveness of IFN retreatment between cirrhotic and noncirrhotic patients, between different HCV genotypes and, finally, between different second course regimens?To increase the statistical power and to resolve uncertainty we propose a meta-analysis of the individual patient' s data (MIPD), drawing from 1 Japanese center and 15 European centers. The aims of this MIPD were (1) to assess the efficacy and tolerability of IFN retreatment in obtaining a complete SR in relapsers; (2) to evaluate which retreatment schedule should be used and, finally, (3) to identify possible predictors of complete SR. Our aims seem particularly important at a time when combination therapy (IFN plus ribavirin) is being confirmed as an effective treatment for relapsers. MATERIALS AND METHODSThe study was planned within the European Concerted Action on Viral Hepatitis (EUROHEP). Twenty-four centers throughout the world, all with reported experience in this field, were invited to participate: 15 centers in Europe and 1 center in Japan agreed to make data available. Individual patient data from previously published and unpublished stud...

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“…Owing to the high mortality risk associated with variceal hemorrhage, primary prophylaxis against a first bleed becomes an important therapeutic intervention [9]. There are several other therapies that are clinically useful for patients with established cirrhosis [14,15], as well as therapies for specific causes of liver disease, such as viral hepatitis [16]. …”

Section: Introductionmentioning

confidence: 99%

A systematic review of the diagnostic accuracy of physical examination for the detection of cirrhosis

Bruyn

Graviss

2001

BMC Med Inform Decis Mak

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BackgroundWe conducted a review of the diagnostic accuracy of clinical examination for the diagnosis of cirrhosis. The objectives were: to identify studies assessing the accuracy of clinical examination in the detection of cirrhosis; to summarize the diagnostic accuracy of reported physical examination findings; and to define the effects of study characteristics on estimates of diagnostic accuracy.MethodsStudies were identified through electronic literature search of MEDLINE (1966 to 2000), search of bibliographic references, and contact with authors. Studies that evaluated indicants from physical examination of patients with known or suspected liver disease undergoing liver biopsy were included. Qualitative data on study characteristics were extracted. Two-by-two tables of presence or absence of physical findings for patients with and without cirrhosis were created from study data. Data for physical findings reported in each study were combined using Summary Receiver Operating Characteristic (SROC) curves or random effects modeling, as appropriate.ResultsTwelve studies met inclusion criteria, including a total of 1895 patients, ranging in age from 3 to 90 years. Most studies were conducted in referral populations with elevated aminotransferase levels. Ten physical signs were reported in three or more studies and ten signs in only a single study. Signs for which there was more study data were associated with high specificity (range 75–98%), but low sensitivity (range 15–68%) for histologically-proven cirrhosis.ConclusionsPhysical findings are generally of low sensitivity for the diagnosis of cirrhosis, and signs with higher specificity represent decompensated disease. Most studies have been undertaken in highly selected populations.

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Chronic hepatitis C and interferon alpha: conventional and cumulative meta-analyses of randomized controlled trials

Cited by 39 publications

References 110 publications

Occult hepatitis C: How convincing are the current data? #

Occult hepatitis C: How convincing are the current data? #

Chronic hepatitis C: Interferon retreatment of relapsers. A meta-analysis of individual patient data

A systematic review of the diagnostic accuracy of physical examination for the detection of cirrhosis

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