title: Efficacy of double filtration plasmapheresis with pegylated interferon/ribavirin therapy for intractable chronic hepatitis C patients and hepatitis C patients with combined liver cirrhosis by HBV, leading to early viral elimination.
abstract: OBJECTIVE
  Therapeutic results for patients with hepatitis C and B complex or patients with genotype lb high viral load treatment-resistant hepatitis C are still not sufficient. The therapeutic effects of concomitant treatment of such intractable patients with double-filtration plasmapheresis (DFPP) and pegylated interferon (PEG-IFN) alpha 2a/ribavirin (RBV) therapy were investigated.
  
  
  METHODS
  The subjects were one patient with genotype 2a hepatitis C combined with liver cirrhosis by HBV and 12 patients with retreated hepatitis C (genotype 2a: two patients, genotype 1b: 10 patients). All subjects were given PEG-IFNalpha2a/RBV therapy (up to 24 weeks for genotype 2a and from 48 to 72 weeks for genotype 1b) and DFPP from the start of treatment for a total of five times. The disappearance of HCV-RNA, hepatic function and peripheral blood were observed with time.
  
  
  RESULTS
  In seven of the 13 patients, HCV-RNA became negative by week 4 of treatment and three became negative by week 12. The remaining three patients became HCV-RNA negative by week 20. In the patient with hepatitis C (genotype 2a) combined with liver cirrhosis by HBV, HBV became negative in week 1 of treatment and HCV-RNA was negative by week 2. Sustained viral response (SVR) was detected in this patient with hepatitis C (genotype 2a) and liver cirrhosis by HBV and in two of the genotype 2a hepatitis C patients. Two of the genotype 1b hepatitis C patients are still HCV-RNA negative at 3 months after completion of treatment and eight patients are currently under observation during treatment.
  
  
  CONCLUSIONS
  Concomitant treatment with PEG-IFNalpha2a/RBV and DFPP is a new modality of hepatitis treatment that causes HCV-RNA to become negative or markedly reduced at an early stage of treatment and induces SVR.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Ibaraki Medical Center, 3-20-1 Chuo, Ami-machi, Inashiki-gun, Ibaraki 300-0395, Japan. oohara8441@jcom.home.ne.jp
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ohara
authors.forename: Takaaki
authors.initials: T
authors.lastname: Oteki
authors.forename: Tori
authors.initials: T
authors.lastname: Suzuki
authors.forename: Masanori
authors.initials: M
authors.lastname: Suzuki
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsuzaki
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D016174:Hepacivirus / Q000187:drug effects / Q000302:isolation & purification; D006509:Hepatitis B / Q000150:complications / Q000628:therapy*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000628:therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000628:therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods*; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a