Pegylated-interferon alpha 2a treatment for chronic hepatitis C in patients on chronic haemodialysis

Sporea, Ioan; Popescu, Alina; Şirli, Roxana; Golea, O; Totolici, Camelia; Dănilă, Mirela; Vernic, Corina

doi:10.3748/wjg.v12.i26.4191

Cited by 65 publications

(55 citation statements)

References 25 publications

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“…Several studies have investigated PEG-IFN alfa monotherapy for hepatitis C in patients with renal dysfunction. [24][25][26][27][28][29][30][31][32] However, most studies were small and included 10 patients or fewer; only four studies included more than 10 patients. 24,25,31,32 Common results included low SVR rates and an unfavorable tolerability profile.…”

Section: Hemodialysis Patients With Chronic Hepatitis C Awaiting Renamentioning

confidence: 99%

“…SVR rates ranged from 30%-75%, with better response rates generally reported in studies with 10 or fewer patients. [26][27][28][29] Two of the larger analyses produced SVR rates of 12%-14%, 24,25 whereas two moderately sized studies produced SVR rates of 50% (n ϭ 34) and 75% (n ϭ 12) (Fig. 2).…”

Section: Hemodialysis Patients With Chronic Hepatitis C Awaiting Renamentioning

confidence: 99%

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Treatment of chronic hepatitis C in hemodialysis patients

Berenguer

2008

Hepatology

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Hepatitis C virus (HCV) infection is especially problematic in patients with end-stage renal disease (ESRD) who are undergoing hemodialysis. Rates of HCV infection are higher among hemodialysis patients than in the general population, and several routes of transmission are thought to stem from the dialysis unit. Management of chronic hepatitis C is also more complicated in hemodialysis patients because of altered pharmacokinetics and a predisposition for drug-related toxicity, particularly ribavirin-induced anemia. Clinical trials of patients with chronic hepatitis C and healthy, functioning kidney grafts are rare because of the inherent dangers of graft rejection. As a result, most studies in patients with ESRD have focused on patients waiting for a kidney transplant. Additionally, because ribavirin is contraindicated in this patient population, many studies have examined monotherapy treatments. According to meta-analyses, conventional interferon alfa treatment yields a sustained virological response (SVR) rate of 37%, whereas studies of pegylated interferon alfa monotherapy have yielded SVR rates between 13% and 75%. Several small studies have also used the monitoring of ribavirin plasma concentrations or hemoglobin levels to facilitate the use of combination therapy. In light of the results from these clinical trials, we herein review treatment guidelines and recommend strategies to help optimize the treatment of patients with ESRD. Conclusion: There remains a lack of clarity surrounding the most effective treatment options for patients with chronic hepatitis C and ESRD. Treatment can be effective with many patients attaining SVR; however, unfavorable tolerability with interferon alfa-based therapy remains a concern and thus close supportive care should be aggressively pursued to help maintain adherence. (HEPATOLOGY 2008;48:1690-1699

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Section: Hemodialysis Patients With Chronic Hepatitis C Awaiting Renamentioning

confidence: 99%

Section: Hemodialysis Patients With Chronic Hepatitis C Awaiting Renamentioning

confidence: 99%

Treatment of chronic hepatitis C in hemodialysis patients

Berenguer

2008

Hepatology

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“…15 PEG IFNs are an attractive option for the treatment of HCV-infected HD patients. [9][10][11][12][13] Although PEG IFN alpha-2b is mainly excreted by the kidneys, 14,22 PEG IFN alpha-2a, because of its pharmacokinetic properties and its prevalent hepatic excretion, could have a greater utilization rationale in patients with various degrees of kidney impairment or with endstage disease. 14 Pharmacokinetics studies have confi rmed the feasibility of PEG IFN alpha-2a therapy at full dosages in patients with creatinine clearance as low as 20 mL/ minute.…”

Section: Peg-ifn Alpha-2a Monotherapy In Hd Hepatitis C Patientsmentioning

confidence: 99%

“…[9][10][11][12][13] In particular, PEG-IFN alpha-2a, because of its hepatic clearance, is an attractive option for patients with ESRD undergoing HD. 14 The aim of this pilot study was to investigate the effi cacy, safety, and tolerability of PEG-IFN alpha-2a in 10 HD patients with chronic hepatitis C.…”

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confidence: 99%

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

Zoppoli

Maio²,

Artioli

et al. 2008

Dialysis & Transplantation

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BACKGROUND In our pilot study, we aimed to treat a group of HCV-infected HD patients with pegylated interferon (PEG-IFN) alpha-2a, a new and potentially efficacious therapeutic possibility. METHODS We treated 10 consecutively enrolled chronic hepatitis C hemodialysis (HD) patients (5 men, 5 women; ages 31-70 years; 7 with genotypes 1-4, 3 with genotypes 2-3) with PEG-IFN alpha-2a (135 μg/week) for 24 weeks (genotypes 2-3) or for 48 weeks (genotypes 1-4). Primary end points were sustained viral response (SVR) rate and safety and tolerability profiles. Secondary end points were rapid response (after 12 weeks of treatment), and response at the end of therapy. RESULTS Viral load reduction was observed in all the patients after 12 weeks of treatment. Seven were HCV-RNA negative and continued therapy. Five patients dropped out before the completion of therapy because of significant adverse events (pancytopenia, severe weight loss). PEG-IFN alpha-2a was reduced to 90 μg/week in 5 patients within the first 4 weeks of therapy. Overall, SVR was 20% at the end of follow-up. CONCLUSION PEG-IFN alpha-2a is efficacious in inducing a fast virological response (12 weeks of therapy) in 70% of HCV-infected HD patients and a considerable fall in liver cytolysis enzymes blood values. The use of granulocyte colony-stimulating factor for neutropenia, starting with lower initial doses of PEG-IFN alpha-2a (e.g., 90 μg/week) or in combination with ribavirin, after appropriate dose adjustment studies, should be evaluated in randomized prospective studies

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“…Only recently, studies have explored pegylated IFN or ribavirin (12)(13)(14)(15)(16)(17)(18). IFN treatment after kidney transplantation is associated with increased rates of allograft rejection (19,20), so treatment before transplantation is advised (21,22).…”

mentioning

confidence: 99%

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

Gordon¹,

Uhlig²,

Lau

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Hepatitis C virus (HCV) infection is prevalent in hemodialysis patientsResults: Twenty studies of IFN treatment provided data on 428 patients. Overall SVR was 45% and in univariate analyses was higher with: 1) three million units or higher three times weekly of IFN; 2) treatment for at least 6 mo; 3) treatment completion; 4) lower baseline HCV RNA; 5) female gender; and 6) early virological negativity. Although limited by missing data, these relationships persisted in multivariate regression.Conclusions: SVR is more likely with larger IFN dose, longer treatment duration, treatment completion, female gender, lower HCV RNA and early virological negativity. For appropriate treatment candidates, regimens should consist of three million units of IFN three times weekly for at least 6 mo, with patients encouraged to complete the full course.

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Pegylated-interferon alpha 2a treatment for chronic hepatitis C in patients on chronic haemodialysis

Abstract: After 12 wk of treatment with Peg-Interferon alpha 2a (40 ku) in patients on chronic haemodialysis with chronic C hepatitis, EVR was obtained in 87.5% (7/8) of the cases. SVR was achieved in 50% of the cases (3/6 patients) that finished the 48 wk of treatment.

Cited by 65 publications

References 25 publications

Treatment of chronic hepatitis C in hemodialysis patients

Treatment of chronic hepatitis C in hemodialysis patients

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

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

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