Recombinant alfa-interferon plus ribavirin therapy in children and adolescents w

[Guest guest]

Recombinant alfa-interferon plus ribavirin therapy in children and

adolescents with chronic hepatitis C.

Wirth S, Lang T, Gehring S, Gerner P.

Children's Hospital Wuppertal, Affiliated Clinic to Witten-Herdecke

University, Wuppertal, Germany. wirth@...

Treatment with alfa-interferon alone yielded poor results in children

with chronic hepatitis C and was not generally recommended. Owing to

limited experience with combination therapy in children, the aim of

the study was to evaluate the efficacy and tolerability of alfa-

interferon 2b in combination with ribavirin in these patients with

different routes of viral transmission. In an uncontrolled pilot

study, 41 children and adolescents ranging from 3 to 16 years were

treated with alfa-interferon at a dose of 3 or 5 MU/m(2) 3 times

weekly in combination with oral ribavirin (15 mg/kg/d) for 12 months.

The mode of infection was unknown in 4, parenterally transmitted in

16, and vertically transmitted in 21 children. Forty patients

completed the study. Eleven children, who remained hepatitis C virus

(HCV)-RNA positive 6 months after the beginning, discontinued

therapy. One boy stopped treatment because of side effects. At the

end of treatment 25 patients were HCV-RNA negative (61%). All

individuals remained HCV-RNA negative during the 6-month follow-up

period. Nine of 15 children with parenteral (56.3%), 14 of 21 with

vertical (66.6%), and 2 of 4 with unknown route of infection

responded. Side effects included minor clinical signs such as fever,

flu-like symptoms, anorexia, and more severe signs (21.4%) such as

the development of thyroid autoantibodies and impairment of thyroid

function. In conclusion, combination of alfa-interferon with

ribavirin seems to be an important advance in the treatment of

chronic hepatitis C in children and adolescents. This also is true

for both vertically infected patients and for individuals with normal

transaminase levels before therapy.