Sustained suppression of hepatitis C virus by high doses of interferon and ribavirin in adult hemophilic patients

Santagostino, Elena; Filippi, Francesca; Rumi, Maria Grazia; Rivi, Monica; Colombo, Massimo; Mannucci, Pier Mannuccio

doi:10.1111/j.1537-2995.2004.03154.x

Cited by 17 publications

(16 citation statements)

References 19 publications

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“…Currently, treatment is usually for 6 or 12 months with a combination of pegylated interferon and ribavirin but is toxic and unpleasant; depression and mood changes are often significant. The overall success rate (elimination of the virus) varies with genotype, 70% for genotypes 2 and 3, but is only 29% for the common type 1 (Santagostino et al , 2004). New antiviral agents are under development (Benhamou et al , 2002).…”

Section: Adverse Effects Of Treatmentmentioning

confidence: 99%

Optimal haemophilia care versus the reality

Bolton‐Maggs

2006

Br J Haematol

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SummaryHaemophilia A and B are inherited bleeding disorders whose diagnosis and management is generally well established and best provided by specialists in a comprehensive care setting. Patients may be put at unnecessary risk if appropriate expertise is not sought for the management of accidents and surgery. The delivery of a high quality comprehensive service to patients with bleeding disorders depends upon defined standards and a network of haemophilia centres in the UK with similar models in other countries. In developing countries, despite a shortage or absence of treatment products, development of local expertise results in an improved outlook and reduction in mortality. Optimal care for severe haemophilia includes accurate diagnosis, early and adequate factor replacement for bleeding episodes and the provision of prophylaxis from an early age to prevent joint bleeding and the consequent arthropathy. Haemophilia treatment is expensive resulting in considerable inequity in provision of care across the world. Despite decades of experience, optimal treatment levels are not robustly defined. Transfusion-transmitted infections continue to have a significant impact on patient management. The development of inhibitory antibodies seriously complicates the management both in morbidity and cost. While gene therapy has not yet produced the hoped-for cure, new technologies will produce improved products.

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Section: Adverse Effects Of Treatmentmentioning

confidence: 99%

Optimal haemophilia care versus the reality

Bolton‐Maggs

2006

Br J Haematol

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“…Conversely, combination therapy of IFN 3 MU with 1 g ribavirin for 48 weeks did increase the rates of SVR in adolescents (59%), whereas it had a negligible impact on adult haemophiliacs (15% SVR) [31]. To circumvent IFN resistance, we treated adult haemophilic patients with high doses (5 MU) of IFN and ribavirin, thus achieving higher SVR (41%) [32]. The same treatment schedule was employed to treat patients who previously had not responded to IFN monotherapy, again with satisfactory SVR rates (36%) [33].…”

Section: Interferon Therapymentioning

confidence: 99%

Hepatitis C in haemophilia: lights and shadows

et al. 2004

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Hepatitis C is a major cause of morbidity and mortality in haemophiliacs who received clotting factor concentrates before the availability of virus-inactivated factors in the mid-1980s. Early studies gave conflicting indications as to the severity of hepatitis C (originally termed non-A non-B hepatitis), as mild, slowly progressive hepatitis was documented in several infants and young adults with haemophilia who were examined with repeat liver biopsies, whereas more progressive hepatitis and cirrhosis was documented in others. One major point of dispute was whether these discrepancies could in part be accounted for by epidemiological differences among studies, as hepatitis C acquired early in life may initially run a benign course and later worsen owing to spontaneous recrudescence of hepatitis or interference with such comorbidity factors as alcohol abuse or infection with the human immunodeficiency virus (HIV). In the mid 1990s, the latter infection overshadowed hepatitis C as a cause of death in this patient population. Because hepatocellular carcinoma is emerging as an important complication in haemophiliacs with long-standing hepatitis C virus (HCV) infection who survived HIV infection, and because of recent advances in treating HIV, morbidity and mortality associated with chronic hepatitis C have regained emphasis amongst haemophiliacs. The development of newer interferon-based therapies provides an opportunity for modifying the natural history of HCV infection in a substantial number of haemophilic patients.

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“…Dose reductions were necessary in 26% of the patients due to side effects. The authors concluded that combined therapy overcomes therapeutic failure to monotherapy in one-third of the patients [15,16]. Lower efficacy of monotherapy with interferon in haemophiliacs had already been documented in a previous study [17].…”

Section: Discussionmentioning

confidence: 94%

Treatment of chronic hepatitis C virus infection among Brazilian haemophiliacs

Pereira

Mangini

2008

Braz J Infect Dis

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Chronic hepatitis C virus (HCV) infection is now the most important cause of liver cirrhosis and hepatocellular carcinoma worldwide. HCV infection prevalence is high among haemophiliacs (39%-98%), who got infected when received inadequately or non-virus-inactivated large-pool clotting factors concentrates before 1992. Current treatment reduces the probability of developing advanced stages of liver disease. The objective of this study was to evaluate efficacy and safety of the treatment with interferon alpha (IFN) and ribavirin in haemophiliacs. From July 2000 to November 2002, 18 patients were treated with IFN, three million units thrice weekly combined with daily oral doses of 1,000 or 1,250 mg of ribavirin for a minimum of 48 weeks. Eleven patients (61%) showed end of treatment virological response, while nine [(50%): 95% CI: 27-73%] showed sustained virological response as defined by undetectable HCV-RNA six months after treatment. All those nine had persistently undetectable HCV-RNA two to four years post-treatment. There was no treatment interruption due to adverse events. Therefore, the rate of sustained virological response was 50%, with good tolerance.

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Sustained suppression of hepatitis C virus by high doses of interferon and ribavirin in adult hemophilic patients

Abstract: High-dose IFN therapy plus ribavirin provided high rates of sustained virologic responses in adult hemophiliacs with chronic HCV, even if side-effects led to dose reduction in half of these patients.

Cited by 17 publications

References 19 publications

Optimal haemophilia care versus the reality

Optimal haemophilia care versus the reality

Hepatitis C in haemophilia: lights and shadows

Treatment of chronic hepatitis C virus infection among Brazilian haemophiliacs

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