Efficacy of peginterferon alpha-2b in chronic hepatitis delta: Relevance of quantitative RT-PCR for follow-up

Abstract

Hepatitis delta virus (HDV) can cause severe acute and chronic liver disease in patients infected by hepatitis B virus. Interferon alpha at high doses, although poorly efficient, is the only treatment reported to provide some benefit in chronic hepatitis delta. Pegylated interferon alpha (PEG-IFN) has not yet been evaluated. Treatment is usually monitored by the qualitative detection of HDV-RNA in serum. In this study, safety and efficacy of PEG-IFN were assessed in chronic hepatitis delta, and serum HDV-RNA kinetics were determined using quantitative RT-PCR. Fourteen patients with chronic hepatitis delta received subcutaneous PEG-IFN alpha-2b during 12 months (1.5 g/kg per week). Serum HDV-RNA was quantified at initiation and during the course of therapy, and during the posttreatment follow-up period, which ranged from 6 to 42 months (median 16 months). PEG-IFN alpha-2b was well tolerated, inducing no serious adverse effect. Sustained biochemical response was obtained in 8 patients (57%). At the end of treatment, 8 patients (57%) had achieved virological response (undetectable HDV-RNA). Sustained virological response throughout the posttreatment follow-up period was observed in 6 patients (43%). HDV-RNA kinetics were predictive of the response: after 3 months of PEG-IFN, HDV-RNA levels were significantly lower in the responders than in the nonresponders group (P ‫؍‬ .018). After 6 months of therapy, a negative HDV-RNA was predictive of sustained response (P ‫؍‬ .021). In conclusion, this preliminary study indicates that PEG-IFN alpha-2b is safe and efficient for treatment of chronic hepatitis delta. H epatitis delta virus (HDV) is a satellite RNA virus, which depends on the hepatitis B virus (HBV) for virion assembly and propagation. 1 HDV infection can cause severe acute and chronic liver disease, with a chronicity rate reaching 70% to 90% in cases of super-infection, 1-3 and a common progression to cirrhosis (60%-70%) accounting for frequent evolution to end-stage liver disease and hepatocellular carcinoma. 4,5 To date, treatment of chronic hepatitis delta relies on interferon alpha (IFN), but the efficacy is limited. 6 Antiviral drugs such as ribavirin, acyclovir, or famcyclovir are inefficient, 7,8 and anti-HBV drugs such as lamivudine, which efficiently reduce HBV viremia but not HBsAg levels have no effect on hepatitis delta, 9 even when associated to IFN. 10 Clevudine, which induces a reduction in the covalently closed circular DNA replication template levels could be useful in the treatment of chronic hepatitis delta but has only been evaluated in the woodchuck model for this indication. 11 The pegylated form of IFN (PEG-IFN), which has been proved to be more efficient than standard IFN in chronic hepatitis B and C, might improve the outcome of chronic hepatitis delta, but such treatment has not yet been evaluated. 12,13 The diagnosis of HDV infection usually relies on the detection of specific anti-HDV antibodies, with the presence of anti-HDV IgM reflecting ongoing viral replication. However, serologi...

Current therapy for hepatitis C or D or immunodeficiency virus concurrent infection with chronic hepatitis B

“…Although treatment is not yet satisfactory, a proportion of patients with chronic hepatitis D benefit form IFN-a treatment, There are five relatively small randomized controlled clinical trials using IFN monotherapy in patients with chronic hepatitis D with a variable dosing (from 3 to 9 MU) and different treatment periods (from 3 to 24 months) ( Table 3). The response is limited and variable depending on the different schedules of treatment [39][40][41][42][43][44][45]. Up to 70% of patients may reach a normal aminotransferase level while on treatment, but the relapse rate is high after discontinuation.…”

“…Improvement in clinical outcome and survival has been reported by Farci et al [44], even in patients with cirrhosis at baseline. Castelnau et al [45] recently reported a study using pegylated IFN-a-2b to treat 14 chronic hepatitis D patients for 12 months. The results disclosed that 57 and 36% of patients achieved virological and biochemical response, respectively.…”

PEG-IFN for the treatment of hepatitis D

“…Treatment with this type of IFN induced rates of sustained virological responses that varied from 17% to 43%4-6 However, these studies also included only a small number of patients and are difficult to compare because of the clinical heterogeneity of the patients; the highest rates of sustained virological response were reported in a series of 14 patients, most of whom did not have cirrhosis (a common complication in patients with HDV). 5 The paper by Wedemeyer and coworkers 7 provides information on what can be achieved with PEG-IFN-2a in patients infected with HBV and HDV. Wedemeyer et al compared the efficacy of PEG-IFN-2a alone versus its combination with adefovir and adefovir monotherapy.…”

Treatment of Chronic Delta Hepatitis: A Nine-Year Retrospective Analysis

“…Moreover, we found a significant correlation between early virological response to PEG-IFN and sustained biochemical response and amelioration of necroinflammation scores of the liver. In recent reports, authors emphasized the importance of EVR in predicting the cases that may need extended treatment (4,(13)(14)(15). One of the striking factors in our study was that higher HDV RNA and HbsAg levels were associated with higher relapse rates in CDH and that the 2-year treatment was not superior to the 1-year treatment.…”