Efficacy of Prolonged Treatment With Pegylated Interferon (Peg-IFN) and Ribavirin in Thalassemic Patients With Hepatitis C Who Relapsed After Previous Peg-IFN-Based Therapy

Abstract

Background:Most thalassemic patients with chronic hepatitis C virus (HCV) infection do not respond to therapy with pegylated interferon (Peg-IFN) plus ribavirin (RBV) due to hepatic siderosis and RBV dose reduction caused by RBV-induced anemia.Objectives:In the present study, we recruited HCV genotype 1-infected thalassemic patients who had relapsed after a 48-week treatment with Peg-IFN plus RBV in order to evaluate the efficacy of a 72-week regimen of Peg-IFN plus RBV.Patients and Methods:In this retrospective study, 23 thalassemic patients with HCV genotype 1 infection who had prior relapse after treatment with Peg-IFN and RBV for 48 weeks were consecutively enrolled in this study for evaluation of the efficacy of a 72-week treatment regimen.Results:For the 21 included cases, mean age was 29.7 years; 81% were men and 28.6% had cirrhosis. At the end of the treatment, nine (42.9%) patients had an undetectable level of HCV RNA in their sera. However, six months after treatment completion four of these patients relapsed and a sustained virological response (SVR) was found in five (23.8%) patients. Undetectable HCV RNA level at week 4 (P = 0.03) and undetectable HCV RNA level at week 12 (P < 0.01) were found to be predictors of SVR. There was an average 47.9% increase in blood transfusion during therapy and treatment was discontinued for 12 (57.1%) patients prematurely.Conclusions:The present study suggests that thalassemic patients with chronic hepatitis C genotype 1 infection who did not achieve SVR after a course of therapy with Peg-IFN and RBV may benefit from being retreated with a 72-week regimen.

Efficacy and Safety of Generic Sofosbuvir/Ledipasvir Fixed-Dose Combination in Iranian Patients with Chronic Hepatitis C Virus Infection

“…Based on these findings, experts and guidelines recommended to intensify the treatment by adding RBV or prolongation of treatment to a 24-week course when patient harbor cirrhosis and/or previous history of treatment and/or NS5A RASs (20). The on-treatment response was the most important predictor of response of SVR in the IFN-based regimens; however, with the introduction of highly efficient IFN-free DAA regimens, the importance of on-treatment response faded (21)(22)(23)). In the current study, the only case with viremia at the week 4 of treatment achieved SVR; however, large-scale studies are needed to clarify the importance of on-treatment response in clinical decision-making in the IFN-free regimens era.…”

A facile PCR‐RFLP method for genotyping of ITPA rs1127354 and rs7270101 polymorphisms

“…This will lead to the resistance of those carrying the ITPA variant to anemia and severe hemoglobin decrease following RBV‐related treatments . Ribavirin is known as a purine nucleoside analogue and one of the fundamental treatments of chronic hepatitis C . The ITPase activity may lead to anemia induction via endogenous purines .…”

Simeprevir/pegylated interferon/ribavirin triple therapy for recurrent hepatitis C after living donor liver transplantation

“…The extension of PEG IFN/RBV dual therapy was also attempted in another situation. A recent study reported that thalassemic patients with HCV infection, who did not respond to dual therapy due to hepatic siderosis and anemia, benefited from an extension of regimen . The strategy of extending dual therapy with PEG IFN/RBV would be applicable for SMV triple therapy.…”