Recombinant interferon-alfa therapy in children with chronic hepatitis C

Abstract

The efficacy of recombinant interferon-alfa therapy in children with chronic hepatitis C has been evaluated in a randomized, controlled pilot study including 27 patients, aged 2 to 14 years, without underlying systemic diseases. On entry, all patients had abnormal alanine transaminase (ALT) levels, 22 were hepatitis C virus (HCV) RNA positive, 19 had mild chronic active hepatitis, and 8 had chronic persistent hepatitis on liver biopsy. Fourteen children received 5 MU/m2 of recombinant interferon-alfa2b thrice weekly for 4 months. If at this time ALT had been reduced to at least 50% the baseline level, treatment was continued up to 12 months. The other 13 children remained untreated. The whole follow-up period lasted 24 months. Interferon was stopped at 4 months in 4 children because of an ALT increase (2 cases), unchanged ALT and febrile convulsions (1 case), and slight ALT decrease (1 case). This latter patient, however, had normal ALT at 6 months and throughout further follow-up, and cleared HCV RNA, thus behaving as a sustained responder. All 10 children treated for 12 months had normal levels of ALT, and 9 were HCV RNA negative at the end of treatment. Of the 9 children who could be followed to 24 months, 4 relapsed soon after therapy withdrawal and 5 maintained a sustained biochemical and virologic response. Overall, 6 (43%) of 14 treated children had a sustained ALT normalization associated with HCV RNA clearance as compared with only 1 (7.5%) untreated child who had a sustained ALT normalization but did not clear HCV RNA.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of Hepatitis C in Children: A Systematic Review

“…These results were borderline statistically significant (p = 0.056), likely due to the small numbers of patients. Bortolotti et al reported that SVR was achieved in 9 of 13 (69%) treated patients and 0 of 13 controls (p<0.001) [17]. Almost all treated patients had flu-like symptoms, and doses of interferon were decreased in 7 of 25 children (28%) due to neutropenia.…”

“…Three included only pediatric populations [17], [18], [19] while one had a mixed pediatric-adult population [20]. All four RCTs were deemed to have an unclear risk of bias based on the Cochrane Risk of Bias tool.…”

Spontaneous remission of chronic hepatitis C in children

“…However, data on the natural history of chronic hepatitis C in children are limited [1,2,6,9]. We monitored the clinical courses of children with chronic hepatitis C to clarify the natural history of the disease and to compare the characteristics of the children with and without spontaneous remission.…”

Long-term virological response and growth rate of children with chronic hepatitis C who received natural interferon-α

“…IFN has been reported to induce responses in children with chronic hepatitis C comparable to or greater than those in adults [1,2,4]. All previous therapeutic trials treated small numbers of children and did not evaluate factors influencing the response.…”