Premenopausal women & hep c

[Guest guest]

http://hivandhepatitis.com/hepc/c12179903.html

Pre-Menopausal Women Have Better

Response Rate to Alfa Interferon for

Chronic Hepatitis C

Response rate is higher than for either men or

post-menopausal women, suggesting a beneficial role for

estrogen in the response to therapy

by Harvey S. Bartnof, MD

Previously, many studies have shown that men have a lower

response rate to alfa * interferon therapy for hepatitis C

than

women. Also, older patients have a lower response rate than

younger patients. (Note that the current standard of care

for

chronic hepatitis C is the combination of alfa interferon

[intron

A, Roferon A, Wellferon] plus Rebetol [ribavirin]). Now,

researchers from Loyola University in Chicago have

determined

that pre-menopausal women have a higher response rate to

alfa

interferon monotherapy than post-menopausal women or men.

A total of 50 premenopausal and 15 postmenopausal women

and 86 age-matched men, all with chronic hepatitis C, were

enrolled in the current study. All three groups had

comparable

HCV RNA viral load levels, liver enzyme increases, HCV

genotype distribution, and liver histology (appearance under

the

microscope) abnormalities. All were treatment-naïve (no

previous treatment for hepatitis C), and none had liver

cirrhosis

(scarring). The patients were treated with a high dosing of

alfa

interferon, 5 million units daily, for six months. The HCV

RNA

viral loads and liver enzyme levels were reported at the end

of

the six-month period ( " end-of-treatment " response). A

response

was defined as an undetectable viral load (limit not stated)

and a

normal ALT (alanine aminotransferase) liver enzyme level.

The results showed that 57% of the men and 69% of the

women responded to therapy. Pre-menopausal women had a

significantly higher response rate (74%) than age-matched

men

(56%). The pre-menopausal women also had a significantly

higher response rate (74%) than post-menopausal women

(47%). However, there was no difference in the response rate

of

post-menopausal women with age-matched men.

The results suggest that the presence of estrogen and/or

progesterone (female hormones) may be a beneficial

co-factor(s)

in the response rate to alfa interferon for women with

chronic

hepatitis C. Similar benefits have been reported for HIV

positive, pre-menopausal women taking HAART (highly active

antiretroviral therapy), when compared to HIV positive,

post-menopausal women.

There are a few limitations to the study. First, even though

the

dose of alfa interferon was higher than the FDA-approved

dose,

the standard-of-care today would be dual therapy with alfa

interferon plus Rebetol. Second, the comparison between pre-

and post-menopausal women might not be statistically

significant

when the confound of age is included in the analysis. Third,

end-of-treatment response rates are usually higher than

sustained

response rates that are measured six months after therapy is

stopped. Nonetheless, the findings are provocative. Given

the

poorer response rate in post-menopausal women and men,

perhaps a study with hormonal manipulation for these two

groups would be indicated. Supplementing post-menopausal

women with female hormones would be an easy intervention.

Testing the same hormonal manipulation for men would be

more problematic. The lead author was Alessandra Colantoni,

MD.

* Note that all four generic versions use the spelling

'alfa' and

not 'alpha.'

alley/

ICQ 12631861

alleypat@... <mailto:alleypat@...>