Impact of pegylated interferon alpha-2B and ribavirin on hepatic fibrosis in liver transplant patients with recurrent hepatitis C: an open-label series.
BACKGROUND
Patients with recurrent hepatitis C virus (HCV) are often treated with interferon-based therapy in an attempt to eradicate HCV and prevent cirrhosis requiring retransplantation. We describe our experience with pegylated interferon and ribavirin and the impact of this therapy on hepatic fibrosis.


METHODS
Patients were treated with pegylated interferon alpha-2b 1.5 mcg/kg/week and ribavirin 800 mg/day for 6-12 months according to genotype. HCV ribonucleic acid (HCV RNA) was repeated at 3 months, end of treatment (EOT) and 6 months after EOT for patients HCV RNA negative at EOT. Liver biopsies were performed prior to treatment and at EOT.


RESULTS
Thirty nine patients were eligible. Twenty two completed treatment and 17 (43.6%) were intolerant. Eleven of 22 (50%) patients who completed treatment developed sustained viral response (SVR). Two patients intolerant to treatment also developed SVR. Serial biopsies were performed in 17 patients and refused in five. Improved fibrosis scores were present in four patients (non-responders, n = 2), unchanged in 10 (non-responders, n = 4), and worse in three (all non-responders).


CONCLUSIONS
Side effects are an important limiting factor in recurrent HCV treatment with SVR only 33.3% in an intention-to-treat analysis. However, improved or stable fibrosis scores were also demonstrated in 66.7% of non-responders. This suggests failure to eradicate HCV should not necessarily lead to treatment discontinuation as a subgroup of patients may benefit from maintenance therapy.
Mukherjee
Sandeep
S
Medicine/Section of Gastroenterology, University of Nebraska Medical Center, Omaha, NE 68198-3285, USA. smukherj@unmc.edu
Lyden
Elizabeth
E
D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control / Q000821:virology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols; D012367:RNA, Viral / Q000032:analysis; D011994:Recombinant Proteins; D012008:Recurrence; D012074:Remission Induction; D012254:Ribavirin / Q000008:administration & dosage*; D016896:Treatment Outcome
D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b