Duration of peginterferon therapy in acute hepatitis C: A randomized trial

Kamal, Sanaa M.; Moustafa, Khairy; Chen, Jason; Fehr, Jutta; Moneim, A. Abdel; Khalifa, Khalifa E.; Gohary, Leila A. El; Ramy, Amr H.; Madwar, M. A.; Rasenack, J.; Afdhal, Nezam H.

doi:10.1002/hep.21197

Cited by 132 publications

(97 citation statements)

References 31 publications

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“…The results reported from Italy 1 are not in line with experiences in Switzerland showing that barriers to interferon-alpha therapy are higher in intravenous drug users than in other patients with acute hepatitis C. 2 We have to stress that patients with ongoing drug abuse were excluded from our study. 3 Nevertheless, our experiences in patients with previous drug abuse are also more in line with the Swiss data than with the study by de Rosa et al demonstrating the importance of thorough patient selection and close monitoring during therapy in the treatment of acute hepatitis C.…”

Section: Replysupporting

confidence: 86%

“…Moreover, the effectiveness of late treatment administered for 8, 12 and 24 weeks was investigated in another study recently published in HEPATOLOGY and showed that the SVR rate increased with the duration of treatment. 3 The SVR rates, when AHC was treated for 8, 12 and 24 weeks, were 67.6%, 82.4% and 91.2%, respectively.Further proof of the importance for early treatment is that negative plasma HCV-RNA was observed 2.5 weeks after the beginning of treatment. We believe this length of time may be shortened since our patients received a variable dosage of PEG-IFN ranging from 1.06 to 1.66 g/Kg/weekly.…”

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confidence: 90%

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confidence: 90%

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Acute hepatitis C: Dosage and compliance

2006

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The HEP-NET study recently published in HEPATOLOGY 1 showed that a 24-week course of PEG-IFN (1.5 g/Kg/weekly) alpha-2b was associated with a SVR of 71% in patients with acute hepatitis C (AHC). Treatment was initiated after spontaneous viral clearance ("late-treatment") was excluded and the SVR rate was similar to that we achieved with a 12-week regimen of PEG-IFN alpha-2b administered without waiting for the spontaneous viral clearance ("early treatment"). 2 Compliance in the HEP-NET study was a major issue and we would like to comment on the early and late treatment strategies of AHC.In our study, including 19 patients of whom 14 were asymptomatic and 11 patients were infected with genotype 1, the SVR was dosagedependent as it was significantly associated by multivariate analysis only with PEG-IFN at a dosage Ն1.33 g/Kg/weekly. 2 The SVR rate was 74%; 100% and 83.3%, respectively, in genotype 1 and non-1 infected patients treated with a dosage Ն1.33 g/Kg. Treatment was administered within 34 days (range: 7-116) of the ALT level peak, and the majority of patients were intravenous drug users (IVDUs).Observations from these two studies show that a SVR is significantly associated with high PEG-IFN dosage in early treatment whereas the SVR may be significantly affected by the compliance in late treatment. Moreover, the effectiveness of late treatment administered for 8, 12 and 24 weeks was investigated in another study recently published in HEPATOLOGY and showed that the SVR rate increased with the duration of treatment. 3 The SVR rates, when AHC was treated for 8, 12 and 24 weeks, were 67.6%, 82.4% and 91.2%, respectively.Further proof of the importance for early treatment is that negative plasma HCV-RNA was observed 2.5 weeks after the beginning of treatment. We believe this length of time may be shortened since our patients received a variable dosage of PEG-IFN ranging from 1.06 to 1.66 g/Kg/weekly. 4 The less time needed to clear HCV-RNA, the lower the intrahepatic viral load.These studies may not indicate the best choice between early or late treatment strategies. However, we all know that compliance is a major issue in IVDUs as most of them do not understand the reasons to wait for a possible spontaneous viral clearance. Therefore, we believe that the benefits of early treatment with high PEG-IFN dosages are greater than those achievable by the late treatment, especially in IVDUs. Reply:We thank De Rosa and colleagues for their comments highlighting that timing of treatment and compliance are major issues in the treatment of acute hepatitis C. We fully agree that treatment of IVDUs with acute hepatitis C is difficult and that earlier treatment may have advantages in certain settings. However, some centers have reported different experiences in the treatment of acute hepatitis C in IVDUs. The results reported from Italy 1 are not in line with experiences in Switzerland showing that barriers to interferon-alpha therapy are higher in intravenous drug users than in other patients with acute hepatitis C. 2 We...

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Section: Replysupporting

confidence: 86%

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Acute hepatitis C: Dosage and compliance

2006

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“…Genotype 4 was nearly as common as genotype 1 and had the highest response (100% SVR) in the 24-week treatment group. 128 In a second study, Kamal et al 129 followed patients for 8 weeks after the identification of acute HCV. Subjects were then randomized to receive pegylated interferon alpha 2b, beginning at 8, 12, or 20 weeks, and they underwent a 12-week treatment regimen.…”

Section: Treatment Of Acute Hcv Infectionmentioning

confidence: 99%

Acute hepatitis C virus infection: A chronic problem

et al. 2008

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S ince the discovery of the hepatitis C virus (HCV) in the late 1980s, there has been an explosion of information regarding its natural history, treatment, and replication cycle. Nonetheless, there are still relatively few data regarding acute HCV infection. By convention, the term acute hepatitis refers to the presence of clinical signs or symptoms of hepatitis for a period of 6 months or fewer after the presumed time of HCV exposure. Early studies of posttransfusion patients who developed non-A, non-B hepatitis provide a clinical picture of early infection. 1 Following the availability of specific serologic and virologic tests, most such patients were shown to have acute HCV infection. After acute infection, HCV RNA may become detectable in the serum/plasma in as little as 2 weeks ( Fig. 1). Several weeks later, a high percentage of patients experience an increase in serum aminotransferase levels consistent with the development of acute hepatocellular injury. In the majority of cases, patients develop mild constitutional symptoms, including abdominal pain, nausea, vomiting, anorexia, and fatigue. During this acute infection, serum aminotransferases often peak below 1000 IU/mL and may return to normal levels. A minority develops sufficient elevations in bilirubin to lead to overt jaundice or the development of dark urine. Unless the clinical suspicion is high, few patients will be tested for HCV RNA or HCV antibody seroconversion. However, in the majority-but not all-of infected patients, HCV RNA persists, and a chronic disease state develops.The reasons for the general lack of data regarding acute HCV infection are multifactorial and include (1) the relatively high percentage of asymptomatic or unrecognized early infections, (2) the lack of large-scale identification of chronic carriers in the general population who serve as a reservoir for infection, and (3) the decreased number of acute infections that occur in controlled clinical settings such as that of blood transfusions. These factors and the lack of nonprimate animal models necessitate reliance on retrospective studies in chronic carriers, the use of limited historical collections of banked sera, and the extrapolation of outcomes based on small disease outbreaks in unique settings (for example, transmission from a physician to a patient in the operating room setting or following parenteral exposure in healthcare workers). Moreover, there exist only a limited number of population cohorts that continue to experience high rates of HCV transmission (for example, Egypt); nonetheless, there is a growing body of information regarding the clinical presentation, natural history, and treatment outcomes of acute HCV infection.In this article, we review the current information regarding our understanding of the epidemiology, virology, and immunology of HCV with a particular emphasis on acute HCV infection. In addition, we review recent data related to interferon-based treatment intervention and propose an algorithm for the diagnosis and management of acute HCV inf...

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“…A shorter treatment duration may be considered for patients infected with HCV genotypes 2 and 3 with a rapid viral response (RVR), i.e. undetectable HCV RNA at treatment week 4 [14].…”

Section: Treatment Recommendations For Adult Patientsmentioning

confidence: 99%