Meta‐analysis: interferon for the treatment of chronic hepatitis C in dialysis patients

Abstract

SUMMARYBackground: The efficacy of interferon monotherapy in dialysis patients with chronic hepatitis C remains unclear, although a number of small clinical trials have been published addressing this issue. Methods and aims: We evaluated the efficacy and safety of initial interferon monotherapy in dialysis patients with chronic hepatitis C by performing a systematic review of the literature with a meta-analysis of clinical trials. The primary outcome was sustained virological response (as a measure of efficacy); the secondary outcome was drop-out rate (as a measure of tolerability). We used the random effects model of Der Simonian and Laird, with heterogeneity and sensitivity analyses. Results: We have identified 14 clinical trials (269 unique patients); two were controlled studies. The mean overall estimate for sustained virological response (SVR) and drop-out rate was 37% [95% confidence interval (CI) 28-48] and 17% (95% CI 10-28),

Monotherapy with Pegylated Interferon Alpha‐2a in Hemodialyzed Patients with Chronic Hepatitis C

“…SVR varies between 15% and 64% according to published data. 16,17 The adjunct of ribavirin to standard IFN therapy has been tried is some small pilot studies in order to achieve greater SVR rates in treated patients. [18][19][20] Ribavirin is cleared by kidneys and cannot be removed during dialysis sessions.…”

Management of hepatitis C virus infection in hemodialysis patients

“…Multiple factors are associated with the high risk of HCV transmission in MHD patients [3] . Standard interferon alpha (ST-IFNα) and pegylated IFNα (PEG-IFNα) are currently the main treatment strategies for HCV infection in MHD patients, and the key problems are how to increase the sustained virological response (SVR), control the side effects and minimize the dropout rates [1,2,[8][9][10] . This review summarizes the advancement in understanding the prevalence, risk factors, monitoring strategy, and more importantly, prophylaxis and treatment of HCV infection in MHD patients.…”

“…The rationale for this recommendation is that ST-IFNα has appeared as effective as PEG-IFNα in MHD persons because its excretion is reduced in these patients, its adverse effects may be lower, and management of adverse effects is relatively easier than PEG-IFNα [1] . Because ribavirin has the high risk of inducing or aggravating hemolytic anemia in uremic patients and can not be removed by hemodialysis, it should be prohibited or used at a markedly reduced daily dose with careful monitoring of anemia and other adverse effects in MHD patients [1,[8][9][10] . If RBV is to be applied, it should be given at an individualized dosing of 200 mg once a day, or 200 mg every other day, or 200 mg thrice weekly after hemodialysis, and substantial hematopoietic support is essential [57] .…”

“…Moreover, a shorter treatment duration of IFNα might be considered in patients with interleukin-28B (IL-28B) genotype rs12979860 CC or rs8099917 TT, but a longer treatment duration should be given in those with IL-28B genotype rs12979860 CT/TT or rs8099917 TG/GG [56] . Though PEG-IFNα can be used and may be associated with improved SVR rates in MHD patients [57] , a group of experts in both kidney and liver disease recom- [10] . Telaprevir and boceprevir are HCV protease inhibitors (PIs) developed in recent years.…”

Interferon for Hepatitis C Virus in Hemodialysis—an Individual Patient Meta-analysis of Factors Associated with Sustained Virological Response

“…Using individual patient data, we investigated the relationship between SVR and patient, viral, and treatment characteristics based on factors previously identified in non-HD patients (7)(8)(9), HD patients (25,26), and our previous meta-analysis of summary data (22). Patient factors included age, gender, duration of HD, and previous kidney transplantation.…”