Meta‐analysis of interferon randomized trials in the treatment of viral hepatitis C in naive patients: 1999 Update

Abstract

The aim of this study was to update our previous meta‐analysis of interferon (IFN) in the treatment of hepatitis C and to analyse new factors, namely, HCV RNA end‐point, patients with cirrhosis and patients with normal ALT. We use the Der Simonian and Laird method, with heterogeneity and sensitivity analyses. Seventy‐six randomized control trials (RCTs) in naive patients were found but we focused our analysis on 59 RCTs with chronic hepatitis C (26 vs. controls and 33 comparing different regimens) and on seven RCTs in acute hepatitis. Interferon‐α (IFN‐α) at 3 MU thrice weekly (TIW) for 12 months exhibited 39% of virological end‐of‐treatment response (ETR) and 17% of virological sustained response (SR), respectively, vs. 1% and 3% in untreated controls (all P < 0.001). There was a significant dose effect (in favour of 6 vs. 3 MU TIW): the virological SR at 6 months were 35% in the 6 MU group (95% CI: 24–47) and 16% in the 3 MU group (95% CI: 8–27) and were at 12 months 43% in the 6 MU group (95%CI: 31–56) and 25% in the 3 MU group (95% CI: 16–37). There was a significant duration effect (12 vs. 6 months) upon the virological SR rate both at 3 and 6 MU: 3 MU provided 14% of virological SR (95% CI: 11–19) in the 12 months group vs. 7% (95% CI: 5–11) in the 6 months group and 6 MU provided 22% (95% CI: 17–29) and 16% (95% CI: 11–22) virological SR in the 12 and 6 months groups, respectively. Cirrhotic treated patients had 17% of virological SR (95 CI: 9–24%; P < 0.001) vs. 0% in controls and provided a 20% reduction rate (95 CI: −2% to −37%, P=0.03) in hepatocellular carcinoma incidence. In acute hepatitis C, a 3‐month treatment with IFN‐α showed significant efficacy vs. controls upon the virological SR rate (32% vs. 4%, P < 0.001). In conclusion, we confirm the dose and duration effect of IFN in chronic hepatitis C, and the efficacy of IFN‐α in the treatment of acute hepatitis and in cirrhotic patients.

Hepatitis C Infection and Chronic Renal Diseases

“…Greater eradication of HCV infection by antiviral therapy has been documented in hemodialysis patients than in those with normal renal function (3,4,41,42,66,67), possibly reflecting the high antiviral drug plasma levels achieved because of reduced renal clearance. Actually, the clearance of PEG-IFN is reduced by 45% in patients with ESRD (68), being mainly affected by the permeability and pore size of dialyzers (69).…”

Role of antiviral therapy in patients with chronic hepatitis B or C virus in preventing the development of hepatocellular carcinoma

“…[58,61,62] Some studies report that the risk of HCC is reduced in these patients independent of fibrosis stage, while among cirrhotic patients that achieve SVR incidence of HCC is reduced by 20%. [63][64][65] In the group of patients with chronic hepatitis treated with IFN ± ribavirin, the incidence rate of HCC is markedly reduced, while in the group of cirrhotic patients data are not sufficient to support the efficacy of therapy to preventing cancer. [64][65][66] A meta-analysis in 2010 compared 20 studies with 4,700 patients overall; the risk in treatment group of HCC was reduced (RR: 0.43, 95% CI: 0.33-0.56).…”

“…[63][64][65] In the group of patients with chronic hepatitis treated with IFN ± ribavirin, the incidence rate of HCC is markedly reduced, while in the group of cirrhotic patients data are not sufficient to support the efficacy of therapy to preventing cancer. [64][65][66] A meta-analysis in 2010 compared 20 studies with 4,700 patients overall; the risk in treatment group of HCC was reduced (RR: 0.43, 95% CI: 0.33-0.56). [58] Pinzoni et al [67] showed that the risk of developing HCC after achieving SVR persisted in patients with HCV-related cirrhosis: among 598 patients with CHC who underwent a complete course of treatment with Peg-IFN and ribavirin, 221 (37%) patients obtained a SVR and throughout the 10-year post-treatment follow-up, 5.8% of these 221 patients developed HCC.…”

Blood cell, liver function, and response changes by PEG-interferon-α2b plus ribavirin with polaprezinc therapy in patients with chronic hepatitis C

“…Treatment with IFN alone is, however, generally associated with a sustained virologic response in fewer than 20% of patients [1][2][3]. Pegylated-interferon (PEG-IFN) given once a week with ribavirin (RBV) administered orally is more effective than a regimen of standard IFN given three times a week [4].…”