Amantadine monotherapy is ineffective in the treatment of hepatitis C virus recurrence in the post-liver transplantation setting.
BACKGROUND
Recurrent hepatitis C virus (HCV) infection is universal after liver transplantation (LT), yet no effective therapy is available. Amantadine (Am) is currently under evaluation. The aim of this study was to assess the safety and the effectiveness of Am monotherapy in LT patients with HCV recurrence.


METHODS
Twelve patients who underwent transplantation 1-4 years earlier were included when there was detectable serum HCV-RNA and histological signs of liver damage with evidence of progressive hepatic fibrosis. Basal Ishak's scores were 2.1 +/- 1.3 and 5.1 +/- 2.7, respectively. Exclusion criteria were histological cirrhosis and comorbidities. All patients were receiving cyclosporine, with or without azathioprine. Amantadine was given orally (200 mg/d) for 3 months.


RESULTS
Eight (67%) patients completed a 3-month treatment course without dose adjustments. Am was reduced to 100 mg/d in 3 cases and withdrawn in 1 due to side effects, namely, insomnia (n = 7; 58%), tremor (n = 4; 33%), headache (n = 2; 17%), asthenia (n = 2; 17%), and dermatitis, diarrhea, and increased creatinine (each n = 1; 8%). Serum HCV-RNA levels decreased in 3 patients, increased in 3, and remained unchanged in the others. Alanine aminotransferase (ALT) remained abnormal in all cases. Liver function test results did not improve.


CONCLUSIONS
Short-term Am monotherapy was ineffective to treat post-LT HCV relapse and was associated with significant side effects.
Muzi
F
F
Liver Transplant Unit, Tor Vergata University of Rome, Surgical Clinic, S. Eugenio Hospital, Rome, Italy.
Orlando
G
G
Ielpo
B
B
Anselmo
A
A
Sabato Ceraldi
S
S
de Liguori Carino
N
N
de'Liguori Carino
N
N
Manzia
T
T
D'Andria
D
D
Tariciotti
L
L
Angelico
M
M
Tisone
G
G
D000547:Amantadine / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006526:Hepatitis C / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D015203:Reproducibility of Results; D017211:Treatment Failure; D019562:Viral Load
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D016572:Cyclosporine; D000547:Amantadine; D001379:Azathioprine