Nonresponders of interferon/ribavirin treatment for recurrent hepatitis C following liver transplantation.
BACKGROUND
Treatment of recurrent hepatitis C (HCV) following liver transplant currently includes alpha-interferon with ribavirin.


OBJECTIVE
The aim of this study is to evaluate nonresponder protocols for patients failing current treatment for recurrent hepatitis C following liver transplantation.


METHODS
From February 1998 through November 2002, 67 patients, all serum RNA-positive for hepatitis C with histological evidence of recurrent hepatitis C, underwent treatment with alpha-interferon and ribavirin. For patients who failed initial treatment, patients were begun on either amantadine along with interferon/ribavirin or peginterferon with ribavirin.


RESULTS
Of the initial 67 patients, there was a complete viral clearance in only 14.9% (10/67). Of the 57 remaining patients not clearing the virus, 30 (52.6%) were taken off treatment due to adverse events associated with bone marrow or hemoglobin suppression. In the amantadine group (n = 12), three (25%) had to discontinue due to CNS side effects of slurred speech, dizziness, and increased depression. In the amantadine group, no patients cleared the virus but there was a one log drop in viral load (1.6 x 10(6) vs 0.9 x 10(6); P =.4). In the peginterferon group, there were three (20%) patients with complete viral clearance during treatment with similar drops to amantadine. There was also seen a biochemical response by month 3 with peginterferon, which was not seen with amantadine.


CONCLUSIONS
Peginterferon with ribavirin appears to be superior to amantadine with interferon/ribavirin when used in nonresponders for hepatitis C viral clearance.
Smallwood
G A
GA
Department of Pharmacy, Emory University Hospital, Atlanta, Georgia, USA. Greg_Smallwood@emoryhealthcare.org
Davis
L
L
Connor
K
K
Martinez
E
E
Stieber
A C
AC
Heffron
T G
TG
D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008111:Liver Function Tests; D016031:Liver Transplantation; D012367:RNA, Viral / Q000302:isolation & purification; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome
D000998:Antiviral Agents; D016898:Interferon-alpha; D012367:RNA, Viral; D012254:Ribavirin