Tratamento de pacientes com hepatite crônica pelo vírus C com interferon-alfa e ribavirina: a experiência da Secretaria de Saúde do Rio Grande do Sul

Alves, Alexandro Vaesken; Azevedo, Andrea Prates da Cunha de; Perin, Chistiano; Ramos, G. Z.; Brandão, Ajácio; Mattos, Ângelo Alves de; Almeida, Paulo Roberto Leiria de

doi:10.1590/s0004-28032003000400006

Cited by 12 publications

(10 citation statements)

References 18 publications

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“…Some of the characteristics of the sample, such as age and the preponderance of both male subjects and genotype 1, demonstrate that the present sample is similar to those from other series of clinical cases, which corroborates the results found and reduces the chance of a selection bias resulting from the loss of data (Zeuzem et al 2000, Alves et al 2003, Figueiredo-Mendes et al 2003, Gonçales et al 2006, Parise et al 2006, Silva et al 2007, Vigani et al 2008, Almeida et al 2009, McHutchison et al 2009). Regarding genotype in particular, previous studies had already demonstrated that genotype 1 is predominant in MT, as it is in most of Brazil (Campiotto et al 2005).…”

Section: Discussionsupporting

confidence: 87%

“…The SVR rate of 32.6% was lower than that observed in prospective studies, which report an SVR of approximately 50% (Manns et al 2001, Fried et al 2002, Brandão et al 2006, Gonçales et al 2006, Silva et al 2007), but similar to that observed in several retrospective studies in the country (Alves et al 2003, FigueiredoMendes et al 2003, Acras et al 2004, Vigani et al 2008, Almeida et al 2009). These numbers suggest that in real-life conditions, the results obtained by the Brazilian healthcare services are not comparable to the results obtained in controlled trials, a fact that should be addressed by the country's public health authorities.…”

Section: Discussionsupporting

confidence: 71%

“…In the past few years, some studies have been published in the Brazilian medical literature describing the experiences of different healthcare service providers In Brazil, the treatment of hepatitis C virus (HCV) (OR: 5.3;CI 95%: 1.7,16.7) and uninterrupted treatment (OR: 9.0;CI 95%: 3.3,45.4 with the treatment of chronic hepatitis C in Brazil (Alves et al 2003, Figueiredo-Mendes et al 2003, Acras et al 2004, Brandão et al 2006, Gonçales et al 2006, Parise et al 2006, Silva et al 2007, Vigani et al 2008, Almeida et al 2009). These reports include experiences in the South and Southeast Regions of the country.…”

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confidence: 99%

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Assessment of the treatment of chronic hepatitis C in the state of Mato Grosso, central Brazil

Azevedo

Azevedo²,

Souto

2012

Mem. Inst. Oswaldo Cruz

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In Brazil, the treatment of hepatitis C virus (HCV) infection is funded by the national public health system (SUS). To evaluate treatment results in the state of Mato Grosso, central Brazil, we have consulted the files of the office of the State Department of Health responsible for supplying such medications. We obtained information on 232 treatments of 201 patients who underwent treatment in or prior to 2008. The study was conducted by reviewing medical records, making telephone calls and interviewing the assistant physicians. Thirty-nine patients (19.4%) had cirrhosis and HCV genotype 1 predominated (64.3%). Excluding patients with comorbidities or treatment without ribavirin we analysed 175 treatments (sustained virologic response occurred in 32.6% of cases). Twenty-six of these 175 were retreatments and the sustained virological response (SVR) rate among them was 30.8%; the SVR rate was 32.9% among those receiving treatment for the first time. The SVR rate of genotype 1 patients was 27.8%, whereas it was 37.5% in non-1 genotype patients. The adjusted multivariate analysis showed association of SVR with the absence of cirrhosis [odds ratio (OR): 7.7; confidence interval (CI) 95%: 2.5, 33.3], the use of pegylated interferon (OR: 5.8; CI 95%: 1.5, 21.4), non-1 genotype (OR: 5.3; CI 95%: 1.7, 16.7) and uninterrupted treatment (OR: 9.0; CI 95%: 3.3, 45.4). The SVR rates were similar to those found in other Brazilian studies about HCV, but lower than those found in national and international clinical trials. These data suggest that the treatments of chronic hepatitis C that are made available by SUS does not, under normal conditions, work as well as the original controlled studies indicated

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 71%

mentioning

confidence: 99%

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Assessment of the treatment of chronic hepatitis C in the state of Mato Grosso, central Brazil

Azevedo

Azevedo²,

Souto

2012

Mem. Inst. Oswaldo Cruz

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“…However, one has to consider that the conventional interferon normally used in the Brazilian public health services comes from various countries, with no prospective and controlled evaluation of virological responses. Observational studies have suggested that virological responses could be inferior to those obtained in the registration trials reported by some investigators [11,12]. This should bring the issue that Brazilian nonresponders may be an easier group to be retreated compared to non Brazilian patients, since there is a lack of quality assurance in the first antiviral therapy in Brazil.…”

Section: Discussionmentioning

confidence: 99%

Peginterferon alfa-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®) in retreatment of chronic hepatitis C patients, nonresponders and relapsers to previous conventional interferon plus ribavirin therapy

Parise¹,

Cheinquer²,

Crespo³

et al. 2006

Braz J Infect Dis

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Peginterferon alfa plus ribavirin is currently the treatment of choice for chronic hepatitis C. Peginterferon alfa-2a (40KD) plus ribavirin has given an overall sustained virological response of 18% in F3/F4 previous nonresponder US patients. We evaluated the effectiveness of peginterferon alfa-2a (40KD) plus ribavirin in Brazilian patients who were relapsers or nonresponders to previous interferon-based therapy. One-hundred-thirty-four patients with biopsy-proven chronic hepatitis C, HCV RNA positive, elevated ALT and who were either relapsers (n=37) or nonresponders (n=97) to at least 24 weeks of conventional interferon/ribavirin therapy were retreated with peginterferon alfa2a (40KD) 180mg/qw and ribavirin 800mg bid for 48 weeks. Efficacy was assessed as virological response (defined as undetectable HCV RNA) at the end of treatment (EoT) and at the end of followup (SVR -Sustained Virological Response). Safety assessments consisted of clinical and laboratory evaluations. In the patient sample, 72% were genotype 1 and 34% were cirrhotic. In an intention-totreat analysis, relapser patients showed 78% EoT response and 51% SVR. Nonresponders showed 57% EoT response and 26% SVR. Positive predictive factors of SVR were non-1 genotype and relapser state. Six percent of the patients interrupted treatment because of adverse events and 45% had dose reduction (mainly associated with leucopenia and anemia). Brazilian patient relapsers and nonresponders to conventional interferon and ribavirin treatment can achieve a sustained virological response when retreated with peginterferon alfa-2a (40KD) and ribavirin. The safety profile is similar to that of naive patients.

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“…A Brazilian study by Alves et al, with 400 patients, reported a 33% sustained response rate to treatment with interferon alpha and ribavirin and it was higher in women and in nongenotype-1 virus [13].…”

Section: Discussionmentioning

confidence: 98%

Treatment of chronic hepatitis C virus infection among Brazilian haemophiliacs

Pereira

Mangini

2008

Braz J Infect Dis

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Chronic hepatitis C virus (HCV) infection is now the most important cause of liver cirrhosis and hepatocellular carcinoma worldwide. HCV infection prevalence is high among haemophiliacs (39%-98%), who got infected when received inadequately or non-virus-inactivated large-pool clotting factors concentrates before 1992. Current treatment reduces the probability of developing advanced stages of liver disease. The objective of this study was to evaluate efficacy and safety of the treatment with interferon alpha (IFN) and ribavirin in haemophiliacs. From July 2000 to November 2002, 18 patients were treated with IFN, three million units thrice weekly combined with daily oral doses of 1,000 or 1,250 mg of ribavirin for a minimum of 48 weeks. Eleven patients (61%) showed end of treatment virological response, while nine [(50%): 95% CI: 27-73%] showed sustained virological response as defined by undetectable HCV-RNA six months after treatment. All those nine had persistently undetectable HCV-RNA two to four years post-treatment. There was no treatment interruption due to adverse events. Therefore, the rate of sustained virological response was 50%, with good tolerance.

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Tratamento de pacientes com hepatite crônica pelo vírus C com interferon-alfa e ribavirina: a experiência da Secretaria de Saúde do Rio Grande do Sul

Cited by 12 publications

References 18 publications

Assessment of the treatment of chronic hepatitis C in the state of Mato Grosso, central Brazil

Assessment of the treatment of chronic hepatitis C in the state of Mato Grosso, central Brazil

Peginterferon alfa-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®) in retreatment of chronic hepatitis C patients, nonresponders and relapsers to previous conventional interferon plus ribavirin therapy

Treatment of chronic hepatitis C virus infection among Brazilian haemophiliacs

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