EFFECTIVENESS OF 48 WEEKS INTERFERON ALFA 2-B IN COMBINATION WITH RIBAVIRIN AS INITIAL TREATMENT OF CHRONIC HEPATITIS
Abstract
Background: Chronic hepatitis C is a common problem worldwide and is becoming an increasingly common problem in Pakistan. This study was done to evaluate effectiveness and safety of 48 weeks combination treatment with Interferon and Ribavirin as initial therapy of chronic hepatitis C patients. Methods: One hundred consecutive patients were prospectively evaluated and treated with combination of Interferon Alfa 2-b three million units subcutaneously three injection weekly and Ribavirin 800-1200 mg orally daily for 48 weeks and followed for another 6 months. End of the treatment, sustained viral response and side effects were noted. Results: Of one hundred patients, 98 completed the treatment. There were 55 males and 43 females. Ages range from 21-60 years, mostly being 31-55 years. Over 83% responded at the end of treatment and four relapsed. Out of treated, 72.7% males and 88.3% females had sustained viral response with a total combined sustained viral response rate of 79.5%. Patients with cirrhosis had 85.7 sustained viral response. Four percent patients took longer than three months to show HCV RNA negativity. Side effects were usual and tolerable and only 2% discontinued the treatment. Non-responders were mostly males above age 50. Conclusion: Forty-eight weeks combination treatment with Interferon alfa 2-b and Ribavirin has given 79.5% sustained viral response in our patients and treatment was well tolerated.Key Words: Chronic hepatitis C, Interferon, RibavirinReferences
Maddrey WC. Update in hepatology. Ann Intern Med 2001; 134: 216-23.
Alter MJ, Kruszon - Moran D, Nainan OV, McQuillan GM, Gao F, Moyer LA, et al. The prevalence of hepatitis C virus infection in the United States. 1998 through 1994. N Engl J Med 1999; 341: 556-62.
Malik IA, Ahmad N, Luqman M. Hepatitis C as a cause of chronic liver disease in Northern Pakistan. J Pak Med Assoc 1992; 42: 67-8.
Mujeeb SA, Jamal Q, Khanani R, Iqbal N, Kaher S. Prevalence of hepatitis B surface antigen and HCV antibodies in hepatocellular carcinoma cases in Karachi, Pakistan. Trop Doct 1997; 27: 45-6.
Malik IA, Khan SA, Tariq WUZ. Hepatitis C virus in perspective: Where do we stand. JCPSP 1998; 6:18.
Luby SP, Qamruddin K, Shah AA, Omair A, Pasha O, Khan AJ, et al. The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan. Epidemiol Infect 1997; 119: 349-56.
Pasha O, Luby SP, Khan AJ. Household members of hepatitis C virus-infected people in Hafizabad, Pakistan: Infection by injections from health care providers. Epidemiol Infect 1999; 123: 515-8.
Khan AJ, Luby SP, Fikree F, Karim A, Obaid S, Dellawala S, et al. Unsage injections and the transmission of hepatitis B and C in a periurban community in Pakistan. Bull World health Organ 2000; 78: 956-63.
Mujeeb SA. Unsafe injections: A potential source of HCV spread in Pakistan. J. Pak Med Assoc 2001; 51: 1-3.
TakaHashi M, Yamada G, Miyamoto R, Doi T, Endo H, Tsuji T. Natural course of chronic hepatitis C. Am J Gastroenterol 1993; 88: 240-3.
Seeff LB. Natural history of hepatitis C In: Liang TJ, Moderator. Pathogenesis, Natural history, treatment and prevention of hepatitis C. Ann Intern Med 2000; 132: 299-300.
Hoofnagle JH, Bisceglie AM. The treatment of chronic viral hepatitis. N Eng J Med 1997; 336: 347-56.
Reichard O, Norkrans G, Frayden A, Braconier J, Sonnerborg A,Weiland O. Randomised, double-blind, placebo-controlled trial of Interferon Alfa-2b with and without Ribavirin for chronic hepatitis C. Lancet 1998; 83-87.
Mc Hutchison JG, Gordon SC, Schiff ER, Shiffman ML, Lee WM, Rustgi VK, et al. Interferon alfa-2b alone or in combination with Ribaviron as initial treatment for hepatitis C. N Eng J Med 1998; 339: 1485-92.
Koff RS. Outcomes and costs of care in hepatitis C: Combination therapy scores again. Am J Gastroenterol 2000; 95: 1392-93.
Ferrell GC. Two years versus six months of Interferon Therapy for chronic hepatitis C. Dig Dis Sci 1996; 125: 935-985.
Ahmed A, Keefe EB. Treatment strategies for chronic hepatitis C: Update since the 1997 National Institute of Health Consensus Development Conference. J Gastroenterol Hepatol 1999; Suppl: S 12-8.
Shiratori Y, Imazeki F, Moriyama M, Yano M, Arakawa Y, Yokosuka O, et al. Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to Interferon therapy. Ann Intern Med 2000; 132: 517-24.
Marcellin P, Boyer N, Gervais A, Martinot M, Pouteau M, Castelnau C, et al. Long-term histologic improvement and loss of detectable Intrahepatic HCV RNA in patients with chronic hepatitis C and sustained response to Interferon alfa-2b therapy. Ann Intern Med 1997; 127: 875-81.
Bennett WG, Inove Y, Beck JR, Wong JB, Pauker SG, Davis GL. Estimates of the cost-effectiveness of a single course of Interferon alfa-2b in patients with histologically mild chronic hepatitis C. Ann Intern Med 1997; 127: 855-65.
Kim WR, Poterucha JJ, Hermans JE, Therneau TM, Dickson ER, Evans RW, et al. Cost-effectiveness of 6 and 12 months of Interferon alfa-2b therapy for chronic hepatitis C. Ann Intern Med 1997; 127: 866-74.
Wong JB, Koff R.S. For the International Hepatitis Interventional Therapy Group. Watchful waiting with periodic liver biopsy versus immediate empirical therapy for histologically mild chronic hepatitis C. A cost-effectiveness analysis. Ann Intern Med 2000; 665-75.
Imai Y, Kawata S, Tamura S, Yanuuchi I, Noda S, Inada M, et al. Relation of Interferon therapy and hepatocellular carcinoma in patients with chronic hepatitis C. Ann Intern Med 1998; 129:94-99
Desmet VJ, Gerber M, Hoofnagle JG, Manns M, Scheuer PJ. Classification of chronic hepatitis: Diagnosis, grading and staging. Hepatology 1994; 19: 1513-20.
Consensus statement: EASL International Consensus Conference on hepatitis C J Hepatol 1999; 30: 956-61.
Maddrey WC. Safety of combination Interferon alfa-2b/ Ribavirin therapy in chronic hepatitis C - Relapsed and treatment - Naive patients. Seminars in liver disease 1999; 19(SI): 67-75.
HO SB, Nguyen H, Tetrick LL, Opitz GA, BasaraML, Dieperink E. Influence of Psychiatric Diagnosis on Interferon alfa-2b treatment for chronic hepatitis C in Veteran population. Am J Gastroenterol 2001; 96: 157-64.
Poynard T, Marcellin P, Lee S, Niederau C, Minuk GS, Ideo G, et al. Randomised trial of Interferon alfa-2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. Lancet 1998; 352; 1426-32.
Tong CY, Khan R, Beeching NJ. The occurrence of hepatitis B and C viruses in Pakistani patients with chronic liver disease and hepatocellular carcinoma Epidemiol Infect 1996; 117: 327-32.
Shah HA, Jafri W, Malik I, Prescott L, Simmonds P. Hepatitis C virus (HCV) genotype and chronic liver disease in Pakistan. J Gastroenterol Hepatol 1997; 12:758-61.
Zeuzem S. Treatment of chronic hepatitis C virus infection in patients with cirrhosis. J viral Hepat 2000; 7: 327-34.
Schalm SW, Weiland O, Hansen BE, Milella M, Lai MY, Hollander A, et al. Interferon - Ribavirin for chronic hepatitis C with and without cirrhosis: analysis of individual patient data of six controlled trials. Eurohep study Group for viral hepatitis. Gastroenterology 1999; 117: 408-13.
Hoofnagle JH. Therapy for hepatitis C. In: Liang TJ, Moderator. Pathogenesis, Natural History, Treatment and prevention of hepatitis C. Ann Intern Med 2000; 132:300-303.
Ebeling F, Lappatainen M, Vuoristo M, Nuutinen H, Leino R, Karvonen A, et al. Factors predicting Interferon treatment response in patients with chronic hepatitis C. Late viral clearance does not preclude a sustained response. Am J Gastroenterol 2001; 96: 1237-42.
Fontana RJ, Moyer CA, Sonnad S, Lok ASF, Sneed-Pee N, Walsh J, et al. Comorbidities and quality of life in patients with Interferon - Refractory chronic hepatitis C. Am J Gastroenterol 2001; 96: 170-78.
Fried MW, Shiffman M, Sterling RK. A multicenter, randomized trial of daily high dose Interferon - alfa 2b for the treatment of chronic hepatitis C: Pretreatment stratification by viral burden and genotype. Am J Gastroenterol 2000; 95: 3225-29.
Glue P, Rouzier-Panis R, Raffanel C, Sabo R, Gupta SK, Salfi M, et al. A dose -ranging study of Pegylated Interferon alfa-2b and Ribavirin in chronic hepatitis C. The hepatitis C internention therapy group. Hepatology 2000; 32: 647-53.
Pianko S, Mc Hutchison J. Retreatment of hepatitis C patients who do not respond to Interferon: The search continues. Am J Gastroenterol 2000; 95: 1122-24.
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