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

February 26, 2008

J Clin Gastroenterol. 2008 Feb 15 [Epub ahead of print]

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

Cirrhosis.

Floreani A, Baldo V, Rizzotto ER, Carderi I, Baldovin T, Minola E.

Departments of *Surgical and Gastroenterological Sciences †Hygiene and Public

Health, University of Padova ‡Department of Infectious Disease, Ospedali

Riuniti, Bergamo, Italy.

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.

PMID: 18285717 [PubMed - as supplied by publisher]

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