Interferon treatment in hemodialysis patients with chronic hepatitis C virus infection: a systematic review of the literature and meta-analysis of treatment efficacy and harms.
BACKGROUND
Hepatitis C virus (HCV) infection is prevalent in patients undergoing hemodialysis and is associated with greater mortality. We determined the efficacy and harms of interferon (IFN) and pegylated IFN (PEG-IFN) treatment of hemodialysis patients with chronic HCV infection and identified factors associated with these outcomes.


METHODS
Meta-analysis and meta-regression of randomized controlled trials, uncontrolled trials, and prospective observational studies.


METHODS
Hemodialysis patients with chronic HCV infection.


METHODS
MEDLINE indexed studies since 1966, sample size greater than 10.


METHODS
IFN-based treatment, including PEG-IFN with and without ribavirin.


RESULTS
Sustained virological response (SVR) 6 months after treatment, rate of treatment discontinuation caused by adverse events, and factors associated with these outcomes.


RESULTS
20 studies of 459 IFN-treated patients, 3 studies of 38 PEG-IFN-treated patients, and 2 studies of 49 PEG-IFN and ribavirin-treated patients met inclusion criteria. The overall SVR rate was 41% (95% confidence interval [CI], 33 to 49) for IFN and 37% (95% CI, 9 to 77) for PEG-IFN. Treatment discontinuation rates were 26% (95% CI, 20 to 34) for IFN and 28% (95% CI, 12 to 53) for PEG-IFN. SVR was higher with 3 million units (MU) or higher of IFN 3 times weekly, with lower mean HCV RNA, and with lower rates of cirrhosis, HCV genotype 1 or elevated transaminase, but these findings were not statistically significant. Treatment discontinuation rates were greater in studies using larger doses.


CONCLUSIONS
Publication bias, few randomized controlled trials, and limitations in generalizability to all hemodialysis patients.


CONCLUSIONS
IFN treatment of hemodialysis patients results in an SVR rate of 41%. Higher dose, lower mean HCV RNA level, and lower rates of cirrhosis, transaminase level increase, and HCV genotype 1 may be associated with greater SVR rates, but additional studies using individual patient data are needed.
Gordon
Craig E
CE
Division of Nephrology, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA 02111, USA.
Uhlig
Katrin
K
Lau
Joseph
J
Schmid
Christopher H
CH
Levey
Andrew S
AS
Wong
John B
JB
D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D007372:Interferons / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012367:RNA, Viral / Q000302:isolation & purification; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012107:Research Design; D016896:Treatment Outcome; D019562:Viral Load / Q000379:methods
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D007372:Interferons; C100416:peginterferon alfa-2a