Excess mortality in patients with advanced chronic hepatitis C treated with long-term peginterferon

April 18, 2011

Hepatology. 2011 Apr;53(4):1100-1108. doi: 10.1002/hep.24169.

Excess mortality in patients with advanced chronic hepatitis C treated with

long-term peginterferon.

Di Bisceglie AM, Stoddard AM, Dienstag JL, Shiffman ML, Seeff LB, Bonkovsky HL,

Morishima C, EC, Snow KK, Lee WM, Fontana RJ, TR, Ghany MG; for

the HALT-C Trial Group.

From the Division of Gastroenterology and Hepatology, Saint Louis University

School of Medicine, St. Louis, MO. dibiscam@....

Abstract

Chronic hepatitis C virus infection can cause chronic liver disease, cirrhosis

and liver cancer. The Hepatitis C Antiviral Long-term Treatment against

Cirrhosis (HALT-C) Trial was a prospective, randomized controlled study of

long-term, low-dose peginterferon therapy in patients with advanced chronic

hepatitis C who failed to respond to a previous course of optimal antiviral

therapy. The aim of this follow-up analysis is to describe the frequency and

causes of death among this cohort of patients. Deaths occurring during and after

the HALT-C Trial were reviewed by a committee of investigators to determine the

cause of death and to categorize each death as liver- or nonliver-related and as

related or not to complications of peginterferon. Rates of liver transplantation

were also assessed. Over a median of 5.7 years, 122 deaths occurred among 1,050

randomized patients (12%), of which 76 were considered liver-related (62%) and

46 nonliver-related (38%); 74 patients (7%) underwent liver transplantation. At

7 years the cumulative mortality rate was higher in the treatment compared to

the control group (20% versus 15%, P = 0.049); the primary difference in

mortality was in patients in the fibrosis compared to the cirrhosis stratum (14%

versus 7%, P = 0.01); comparable differences were observed when liver

transplantation was included. Excess mortality, emerging after 3 years of

treatment, was related largely to nonliver-related death; liver-related

mortality was similar in the treatment and control groups. No specific cause of

death accounted for the excess mortality and only one death was suspected to be

a direct complication of peginterferon. Conclusion: Long-term maintenance

peginterferon in patients with advanced chronic hepatitis C is associated with

an excess overall mortality, which was primarily due to nonliver-related causes

among patients with bridging fibrosis.

(HEPATOLOGY 2011;).

PMID: 21480316 [PubMed - as supplied by publisher]PMCID: PMC3073857 [Available

on 2012/4/1]

April 18, 2011