Glucocorticosteroids for viral hepatitis C

Brok, Jesper; Mellerup, Martin Thyge; Krogsgaard, Kim; Gluud, Christian

doi:10.1002/14651858.cd002904.pub2

Cited by 8 publications

(6 citation statements)

References 59 publications

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“…Current literature analyses in Cochrane database [Brok et al, , 2009], reported that there is not enough information to consider corticosteroids as beneficial or harmful drugs on natural history of chronic hepatitis C.…”

Section: Discussionmentioning

confidence: 99%

Does low‐dose prolonged steroid therapy affect the natural history of chronic hepatitis C?

Romero-Gutiérrez

Campo

Zamora

et al. 2014

Journal of Medical Virology

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Chronic hepatitis C patients may require steroids due to other comorbidities. However, there is not enough information to consider steroids as beneficial or harmful drugs on natural history of chronic hepatitis C. The aim of the present study was to examine the effect of low-dose prolonged therapy with corticosteroids with or without azathioprine on these study patients. A retrospective-prospective observational study was established. Twenty-eight patients with chronic hepatitis C and treated with corticosteroids at low-dose (≤30 mg/day) with or without azathioprine for more than 6 months were included. AST, ALT, HCV RNA, and liver fibrosis were determined, and results were compared with a control group of non-treated chronic hepatitis C patients. The mean age was 47 ± 10 years. The male proportion was 43%. The mean dose of prednisone was 9 ± 5 mg/day (range: 2.5-30 mg/day). The mean treatment time was 76 ± 80 months (range: 7-349 months). Thirty six percent received concomitant azathioprine. Transaminases decreased significantly only within the first 3 months of treatment, with non-significant changes thereafter. Corticosteroids led to a non-significant increase in HCV RNA. Knodell Histology Activity Index decreased (from 8.5 ± 3.7 to 4.7 ± 1.7; P = 0.1). Fibrosis progression per year (final fibrosis stage-initial fibrosis stage/time between explorations, in years), was lower in treated cases than in control group (0.054 ± 0.25 units vs. 0.196 ± 0.6 units, P = 0.26). In conclusion, corticosteroid treatment caused a significant initial decrease in transaminases, non-significant changes in HCV RNA, and a trend to a slower fibrosis progression in comparison to a control group. Therefore, corticosteroids did not accelerate progression of chronic hepatitis C.

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Section: Discussionmentioning

confidence: 99%

Does low‐dose prolonged steroid therapy affect the natural history of chronic hepatitis C?

Romero-Gutiérrez

Campo

Zamora

et al. 2014

Journal of Medical Virology

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“…No statistically significant effect of steroids on the virological response at the end of treatment was found in patients with HCV. 52 By contrast, pretreatment with steroids was associated with a considerably higher frequency of loss of hepatitis B e antigen and HBV DNA, although no statistically significant effect on clinical outcomes was found. 53 However, mechanistic studies have shown that glucocortico steroids can interfere with signal transduction of the interferon receptor.…”

Section: ◀ Perspectivesmentioning

confidence: 91%

“…Two systematic Cochrane reviews with meta-analyses of randomized, controlled trials have been performed in the settings of chronic HCV 52 and HBV 53 infection to comprehensively assess the effects of gluco corticosteroids on interferon antiviral therapy. No statistically significant effect of steroids on the virological response at the end of treatment was found in patients with HCV.…”

Section: ◀ Perspectivesmentioning

confidence: 99%

Virus–drug interactions—molecular insight into immunosuppression and HCV

Pan

Tilanus

Metselaar

et al. 2012

Nat Rev Gastroenterol Hepatol

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Liver transplantation is an effective treatment for end-stage liver disease that is attributable to chronic HCV infection. However, long-term outcomes are compromised by universal virological recurrence in the graft. Reinfection that occurs after transplantation has increased resistance to current interferon-based antiviral therapy and often leads to accelerated development of cirrhosis. Important risk factors for severe HCV recurrence are linked to immunosuppression. Owing to the lack of good randomized, controlled trials, the optimal choice of immunosuppressants is still debated. By contrast, much progress has been made in the understanding of HCV biology and the antiviral action of interferons. These new insights have greatly expanded our knowledge of the molecular interplay between HCV and immunosuppressive drugs. In this article, we explore the effect of different immunosuppressants on the complex cellular events involved in HCV infection and interferon signalling. Potential implications for clinical practice and future drug development are discussed.

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“…A Cochran review from 2004 analyzed eight randomized clinical trials that used glucocorticoids for the treatment of hepatitis C with or without associated autoimmune disorders. There was insufficient evidence to confirm either harm or benefit of glucocorticoids in this setting [23].…”

Section: Immunosuppressive Medications Glucocorticoidsmentioning

confidence: 95%

Current Treatment of Cryoglobulinemic Vasculitis

Goglin

Chung

2016

Curr Treat Options in Rheum

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This article is part of the Topical Collection on Vasculitis Keywords Cryoglobulinemic vasculitis I Hepatitis C I Interferon I Antiviral therapy I Rituximab I Plasma exchange Opinion statement For patients with cryoglobulinemic vasculitis, we consider treatment of the underlying disorder (if present) to be first-line therapy. For hepatitis C virus (HCV)-associated cryoglobulinemic vasculitis, antiviral therapy directed at HCV should be considered firstline treatment for patients who are candidates. Interferon-free direct acting antiviral regimens have been shown to be very effective in the treatment of chronic HCV infection and preliminary results of the use of these regimens are promising for the treatment of HCV-associated cryoglobulinemic vasculitis. Close collaboration with a gastroenterologist or hepatologist is needed, given the complexity in choosing from the various treatment options. Patients with severe life-or organ-threatening manifestations of cryoglobulinemic vasculitis may benefit by treatment with rituximab in addition and potentially prior to the initiation of antiviral therapy. We also recommend treatment with rituximab in patients who have a contraindication to or who have failed antivirals. Plasmapheresis, in conjunction with immunosuppression, can be used as adjunctive therapy to antiviral and/or rituximab therapy for patients with severe organ-or lifethreatening disease. Cyclophosphamide use is best reserved for patients with severe disease who are unable to be treated with antiviral or rituximab therapy. The role of glucocorticoid use remains poorly defined, with some studies supporting moderate or high-dose prednisone use to treat active disease.

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Glucocorticosteroids for viral hepatitis C

Abstract: Analysis 2.1. Comparison 2 Long-term glucocorticosteroids versus interferon, Outcome 1 Mortality and liver related morbidity

Cited by 8 publications

References 59 publications

Does low‐dose prolonged steroid therapy affect the natural history of chronic hepatitis C?

Does low‐dose prolonged steroid therapy affect the natural history of chronic hepatitis C?

Virus–drug interactions—molecular insight into immunosuppression and HCV

Current Treatment of Cryoglobulinemic Vasculitis

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