Prolonged Therapy of Advanced Chronic Hepatitis C with Low-Dose Peginterferon

Bisceglie, Adrian M. Di; Shiffman, Mitchell L.; Everson, Gregory T.; Lindsay, Karen L.; Everhart, James E.; Wright, Elizabeth C.; Lee, William M.; Lok, Anna S.; Bonkovsky, Herbert L.; Morgan, Timothy R.; Ghany, Marc G.; Morishima, Chihiro; Snow, Kristin K.; Dienstag, Jules L.

doi:10.1056/nejmoa0707615

Cited by 429 publications

(423 citation statements)

References 19 publications

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“…30 Recently Di Bisceglie et al reported that low-dose maintenance therapy with peginterferon failed to reduce the incidence of HCC in HCV-positive patients with bridging fibrosis. 31 However, the annual incidence rate of HCC was approximately 1% in their study, in which the patients were around 50 years old. A Japanese retrospective study found that interferon therapy reduced the annual incidence of HCC from 6%-8% to 4%-5% in cirrhotic patients aged about 60 years.…”

Section: Discussionmentioning

confidence: 84%

Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

Kagawa

Koizumi

Kojima

et al. 2010

Cancer

104

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the Tokai RFA Study Group BACKGROUND: Radiofrequency ablation (RFA) is becoming a well-known local therapy for hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) is expected to enhance the effects of subsequent RFA by reducing arterial blood flow. However, the long-term efficacy of this combined therapy has not been elucidated. In this study, the survival rates of patients who received TACE combined with RFA (TACE þ RFA) were compared with those of patients treated surgically. METHODS: The study included consecutive patients who received TACE þ RFA or surgical resection as the initial curative treatment for HCC between 2000 and 2005 at Tokai University Hospital. Inclusion criteria were a single HCC 50 mm or up to 3 HCCs 30 mm, presence of cirrhosis classified as Child-Pugh class A, no vascular invasion, and no extrahepatic metastasis. RESULTS: Sixty-two patients (23 women, 39 men; aged 67.5 AE 8.4 years [mean AE standard deviation]) received TACE þ RFA, and 55 patients (15 women, 40 men; aged 66.1 AE 8.4 years) underwent surgical resection. Median follow-up periods were similar (50 months in the TACE þ RFA group vs 49 months in the resection group). The probabilities of overall survival at 1, 3, and 5 years in the TACE þ RFA group (100%, 94.8%, and 64.6%, respectively) were similar (P ¼ .788) to those in the resection group (92.5%, 82.7%, and 76.9%, respectively). Two major RFA-related complications were observed (1.5%). CONCLUSIONS: RFA combined with TACE is an efficient and safe treatment that provides overall survival rates similar to those achieved with surgical resection. Cancer 2010;116;3638-44.

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Section: Discussionmentioning

confidence: 84%

Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

Kagawa

Koizumi

Kojima

et al. 2010

Cancer

104

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“…It is also important to note that there were no improvements in fibrosis stage or progression after long-term maintenance therapy with pegylated interferons or in posttransplant patients who failed to achieve SVR with HCV therapy. 13,14 The objective of this analysis was to assess the histologic response to interferon-based therapies, based on changes in the METAVIR necroinflammatory (NIF) activity and fibrosis scores in a large group of patients with varying degrees of virologic response, time to HCV RNA undetectability, and duration of viral suppression.…”

mentioning

confidence: 99%

Histologic Outcomes in Hepatitis C–Infected Patients with Varying Degrees of Virologic Response to Interferon-Based Treatments

Pockros

Hamzeh²,

Martin

et al. 2010

Hepatology

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Patients with chronic hepatitis C with partial virologic response or nonresponse to interferon‐based therapies can experience treatment‐related improvements in liver histology. This retrospective analysis assessed the histologic response to treatment in patients with varying degrees of virologic response (sustained virologic response [SVR], breakthrough, relapse, or nonresponse), time to hepatitis C virus (HCV) RNA undetectability, and duration of viral suppression. Patients (HCV genotypes 1‐6) with baseline and follow‐up liver biopsies from eight phase 2 to phase 4 interferon‐based trials were analyzed. Blinded biopsies were evaluated by a single pathologist. Improvements or worsening of METAVIR necroinflammatory activity and fibrosis were defined as increase or decrease of ≥1 grading category from baseline to 24 weeks after end of treatment. A majority of the 1571 patients with paired biopsy data were white, male, with HCV genotype 1/4, baseline HCV RNA levels >800,000 IU/mL, and baseline alanine aminotransferase levels ≤3 × upper limit of the normal range; mean baseline activity and fibrosis scores were 1.8 and 1.7, respectively. Overall, 80% of patients received peginterferon alfa‐2a monotherapy or peginterferon alfa‐2a/ribavirin combination therapy. Mean treatment duration was 46 weeks. There was a positive correlation between the degree of virologic response and improvements in METAVIR activity and fibrosis, and an inverse correlation with worsening activity and fibrosis (all comparisons, P < 0.0001). Patients with SVR had the greatest histologic benefit. As a combined group, relapsers and patients with breakthrough had significantly greater benefits than nonresponders (activity, P = 0.0001; fibrosis, P = 0.003). Consistent with these results, a better histologic response was correlated with a shorter time to undetectable HCV RNA and a longer duration of viral suppression (all comparisons, P < 0.0001). Conclusion: In patients with chronic hepatitis C who were treated with interferon‐based therapies, histologic benefits may be observed even in the absence of an SVR. (HEPATOLOGY 2010;)

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“…In contrast, Giannini et al [58] reported that nonresponse to a previous antiviral therapy is an important determinant of reduced response to full-dose therapy with peginterferon and ribavirin in cirrhosis and portal hypertension. Di Bisceglie et al [59] noted that long-term half-dose peginterferon therapy did not suppress disease progression and HCC development in cirrhotic patients who did not respond to initial peginterferon plus ribavirin therapy and concluded that this therapy is not indicated for these patients.…”

Section: Antiviral Therapy For Hepatitis B Virus Related Cirrhosismentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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Prolonged Therapy of Advanced Chronic Hepatitis C with Low-Dose Peginterferon

Cited by 429 publications

References 19 publications

Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

Histologic Outcomes in Hepatitis C–Infected Patients with Varying Degrees of Virologic Response to Interferon-Based Treatments

Evidence-based clinical practice guidelines for liver cirrhosis 2015

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