Treatment of cirrhotic patients in the pegylated interferon era.
Chronic hepatitis C is a leading cause of cirrhosis, hepatocellular carcinoma, digestive tract haemorrhage and hepatic insufficiency. The present best strategy to prevent severe complications of chronic hepatitis C is the decrease of fibrosis progression. Recently, pegylated interferon combination treatments of chronic hepatitis C have made it possibly to obtain 60% sustained virological responses. Pooled individual data from 3,010 naïve patients with pre-treatment and post-treatment biopsies from 4 randomised trials have shown that all regimens significantly reduced the fibrosis progression rates in comparison to the pre-treatment ones. Six factors were independently associated with the absence of significant fibrosis after treatment: baseline fibrosis stage, sustained viral response, age <40 years, body mass index <27 kg/m2, no or minimal baseline activity, and viral load <3.5 x 10(6) copies/ml. In virological non-responders after the combination of ribavirin and pegylated interferon, the best strategy is still unknown. From a scientific point of view these patients should be included in randomised trials of maintenance therapy. From a pragmatic point of view, if inclusion in a trial is not possible, treatment with low-dose pegylated interferon can be considered in patients with rapid fibrosis progression rates or high risk factors. Non-invasive biochemical markers of liver fibrosis should facilitate the management.
Poynard
Thierry
T
Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France. tpoynard@teaser.fr
D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use; D007372:Interferons / Q000008:administration & dosage / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000517:prevention & control* / Q000628:therapy; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000627:therapeutic use; D011994:Recombinant Proteins; D012256:Riboflavin / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D007372:Interferons; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a; D012256:Riboflavin