Pegylated Interferon Alpha-2b Plus Ribavirin for Naive Patients With HCV-related Cirrhosis

June 26, 2008

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Pegylated Interferon Alpha-2b Plus Ribavirin for Naive Patients With HCV-related

Cirrhosis.

LIVER, PANCREAS AND BILIARY TRACT

Journal of Clinical Gastroenterology. 42(6):734-737, July 2008.

Floreani, rosa MD *; Baldo, Vincenzo MD +; Rizzotto, MD *;

Carderi, Isabella MD *; Baldovin, Tatjana PhD +; Minola, Eliseo MD ++

Abstract:

Background: Data on the efficacy of antiviral therapy in patients with

HCV-related compensated cirrhosis are generally drawn from analyzing subgroups

in larger trials.

Aims: (1) To analyze the safety and efficacy of combination therapy in naive

patients with HCV-related cirrhosis; (2) to evaluate the factors influencing the

sustained virologic response (SVR) in cirrhotic patients by comparison with a

group of noncirrhotic patients; (3) to analyze the outcome of cirrhotic patients

either acquiring SVR and nonresponders to the antiviral therapy during the

posttreatment follow-up.

Methods: We consecutively enrolled 365 patients with biopsy-proven HCV-related

chronic hepatitis meeting the inclusion criteria for pegylated interferon a-2b

plus Ribavirin: 87 patients had compensated liver cirrhosis and 278 had

histologic stages between 1 and 4 according to Ishak's classification.

Results: The 2 groups were comparable for genotype, viral load, and alanine

transferase at presentation. Cirrhotic patients were significantly older and had

significantly higher body mass index, serum ferritin, and gamma-glutamyl

transpeptidase. The rate of side effects was similar in the 2 groups, whereas

the rate of SVR was significantly lower in cirrhotic (45.9%) than in

noncirrhotic patients (65.8%). Logistic regression analysis showed that genotype

1 to 4 and high viral load were independent variables correlating with

nonresponse in the sample as a whole. During follow-up, hepatocellular carcinoma

developed in 5/38 (13.2%) cirrhotic patients not responding or relapsing after

treatment. No cases of hepatocellular carcinoma were seen among cirrhotic or

noncirrhotic patients with a SVR.

Conclusions: Cirrhotic patients with compensated disease have a reasonably good

chance of virologic response and should be offered treatment, carefully

monitoring any side-effects.

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