Treatment of Hepatitis C in Hemodialysis Patients with Pegylated Interferon α-2a as Monotherapy

Abstract

Background. The high prevalence of hepatitis C virus (HCV) infection in hemodialysis patients is of great concern because they have a higher rate of mortality than HCV-negative hemodialysis patients. The aim of the study was to evaluate the efficacy and safety of pegylated interferon α-2a monotherapy in hemodialysis patients with chronic HCV infection. Methods. Fourteen dialysis patients with chronic HCV infection were scheduled to receive 135 μg pegylated interferon α-2a subcutaneously, once a week, after dialysis session for a period of 48 weeks. Efficacy and safety were assessed by end of treatment viral response, sustained viral response, biochemical response, and adverse events. Serum HCV RNA levels were assessed using reverse transcriptase polymerase chain reaction (RT-PCR), while HCV genotype was analyzed by RT-PCR followed by hybridization of amplified products. Results. Of the 14 patients enrolled in the study, 9 completed treatment. Eight patients (57%) had undetectable levels of HCV RNA at the end of treatment, while one patient remained positive. Two (14.3%) patients were discontinued because of insufficient therapeutic response. Three patients (21.34%) did not finish treatment because serious adverse events occurred: one patient with bronchopneumonia and one with pericarditis were discontinued from treatment, while one patient died due to cerebral hemorrhage. Sustained viral response was present in 36% of the patients (5/8 patients) at the end of the follow up

Pegylated interferon monotherapy of chronic hepatitis C in dialysis patients: Meta‐analysis of clinical trials

“…Casanovas-Taltavull et al [2007] Ucmak et al [2008] 6 (50) 9 (75%) 8 (0.80) NA Sikole et al [2008] 5 (41.6) 8 (57.1) NA NA Liu et al [2008] 12 (48) 23 (92) NA NA Ayaz et al [2008] 11 (50) Mukherjee et al [2003] a 8 (89) Diplopia (n ¼ 1), headache (n ¼ 1), depression (n ¼ 2), fatigue (n ¼ 1), liver insufficiency (n ¼ 2) Annichiarico and Siciliano [2004] 2 (33) Anemia (n ¼ 1), diarrhoea (n ¼ 1) Teta et al [2005] 1 (33) Pneumonia Rivera et al [2005] 1 (14) Pancytopenia Russo et al [2006] 7 (44) Hypertension (n ¼ 2), seizures (n ¼ 1), infection (n ¼ 2), graft necrosis (n ¼ 1), dehydratation (n ¼ 1) Covic et al [2006] 11 (14) Acute abdomen (n ¼ 1), depression (n ¼ 1), stroke (n ¼ 2), sepsis (n ¼ 4), thrombocytopenia (n ¼ 3) Chan et al [2007] 2 (33) Cholangitis (n ¼ 1), ischaemic heart disease (n ¼ 1) Espinosa et al [2007] 6 (37.5) Acute abdomen (n ¼ 1), seizures (n ¼ 1), neutropenia (n ¼ 1), heart disease (n ¼ 1), vasculitis (n ¼ 1), prostatic carcinoma (n ¼ 1) Casanovas-Taltavull et al [2007] 3 (25) Fever (n ¼ 1), anemia (n ¼ 1), stroke (n ¼ 1) Sikole et al [2008] 3 (21) Pericarditis (n ¼ 1), pneumonia (n ¼ 1), cerebral hemorrhage (n ¼ 1) Ayaz et al [2008] 5 (23) Anaemia (n ¼ 2), weakness (n ¼ 2), gastrointestinal bleeding (n ¼ 1)…”

“…Three studies concerned pegylated IFN for acute hepatitis C [Engel et al, 2007;Griveas et al, 2007;Lederer et al, 2008]. The remaining 16 studies [Mukherjee et al, 2003;Annichiarico and Siciliano, 2004;Rivera et al, 2005;Teta et al, 2005;Covic et al, 2006;Russo et al, 2006;Sporea et al, 2006;Amarapurkar et al, 2007;Casanovas-Taltavull et al, 2007;Chan et al, 2007;Espinosa et al, 2007;Akhan et al, 2008;Ayaz et al, 2008;Liu et al, 2008;Sikole et al, 2008;UcMak et al, 2008] representing a total of 254 unique patients, were included in the metaanalysis.…”

Treatment of hepatitis C in hemodialysis patients using pegylated interferon α-2a in Turkey

“…Sustained viral response was observed in both patients with chronic infection. Sikole et al [11] treated 14 HD patients with chronic HCV infection with peg-IFN-a-2a and sustained viral response was achieved in five (35.7%) patients while early viral response was present in ten (71.4%) patients. However, the authors reported restrictions of treatment due to the high incidence of side effects.…”

“…The only therapeutic agent that has been proven to be effective was interferon alpha. Recent studies recommended treatment of HCV infection in HD patients with pegylated interferon as monotherapy, which resulted with a higher rate of response than treatment with conventional interferon [9][10][11][12]. However, the experience with pegylated interferon in these patients is limited, the aim of the present study was to evaluate the efficacy and tolerability of pegylated interferon a-2a (peg-IFN-a-2a) used as monotherapy in HD patients with chronic HCV infection.…”

Single nucleotide polymorphisms near IL28B gene and response to treatment of chronic hepatitis C in hemodialysis patients

“…The antivirological treatment is prolonged and expensive, complicated by frequent and sometimes serious side effects resulting in treatment discontinuation, and about one-third of the treated hemodialysis patients achieve sustained virological response. [14][15][16][17][18] The HCV genotype 1 is the most common genotype and one of the most difficult to treat despite the need for 48 weeks of treatment. 19 For all these reasons, it is very important to have a possibility to predict which patients are more likely to respond to antivirological therapy before starting the treatment of chronic hepatitis C. Host genetic factors may predict the outcome of the HCV infection treatment.…”