Interferon alfa‐2b plus ribavirin for chronic hepatitis C patients who have not responded to interferon monotherapy

Iacono, L O; Castro,; Diago,; Moreno,; Fernandez-Bermejo, Miguel; Vega, J.; Garcia, Justin R.; Carbonell,; Sanz,; Borque,; García-Buey,; García-Monzón,; Pedreira,; Moreno-Otero,

doi:10.1046/j.1365-2036.2000.00713.x

Cited by 18 publications

(19 citation statements)

References 28 publications

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“…These include infection with non-type 1 genotypes, 45,49,87,88 a lower baseline HCV-RNA titer or early loss of HCV RNA during treatment, 23,49,56,85,88 treatment duration of 48 weeks, 53,60 non-black race, 52,88 absence of cirrhosis, 21,39,43,74 induction therapy with IFN, 48,52,58,59 and previous partial virologic response to IFN monotherapy. 51 Our sensitivity analysis suggested that a higher response rate was associated with nontype 1 genotypes (14.7% [95% CI 10.…”

Section: Discussionmentioning

confidence: 99%

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Interferon and ribavirin for patients with chronic hepatitis C who did not respond to previous interferon therapy: A meta-analysis of controlled and uncontrolled trials

Cheng

2001

Hepatology

101

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The efficacy of interferon (IFN) combined with ribavirin for the treatment of patients with hepatitis C who failed to respond to initial IFN therapy is not well established. The primary goal of this study was to perform a systematic review of the literature evaluating the efficacy of combination therapy in nonresponders. Studies were retrieved from MEDLINE, abstracts of scientific meetings, and review of the bibliographies of retrieved studies. Controlled trials were included in the primary analysis whereas uncontrolled trials and trials reported as abstracts were included for sensitivity analysis. The primary endpoints were biochemical and virologic response. A combined estimate of the odds ratio (OR) for each endpoint was obtained by using the random effects model. The number needed to treat (NNT) was calculated by taking the inverse of the pooled risk difference. Nine controlled trials (789 patients) were identified. Six months after treatment, the overall sustained biochemical and virologic responses to 24 weeks of combination therapy were 15.2% and 13.2% with a common OR of 3.8 (95% confidence interval [CI] 2.2-6.7) and 4.9 (95% CI 2.1-11.2) compared with patients treated with IFN monotherapy. The pooled risk difference for the sustained virologic response (SVR) to combination therapy was 7% (95% CI 2-13). The NNT was 14 (95% CI Chronic hepatitis C virus (HCV) infection is a major cause of liver disease worldwide. 1 Interferon (IFN) alfa was the first approved therapy but resulted in a sustained virologic response (SVR) in only a minority of patients. A major advance in treatment was the observation that the addition of ribavirin to IFN (combination therapy) was associated with a significantly higher SVR rate compared with IFN alone. Four large, international multicenter studies have shown that combination therapy was substantially more effective than IFN monotherapy in patients who had previously relapsed virologically or biochemically after IFN monotherapy (relapsers), and in patients who had never been treated with IFN (naive patients). [2][3][4][5] Much less is known about the efficacy of combination therapy in patients who failed to respond to IFN monotherapy (nonresponders), a group representing more than one half of all patients treated with IFN. 6 A number of uncontrolled studies and an increasing number of controlled trials have suggested that the efficacy of re-treatment with combination therapy may be higher than for re-treatment with IFN alone. However, the rate of SVR after combination therapy in nonresponders has varied among available reports. Furthermore, the extent to which a response can be predicted by patient-or treatment-related characteristics remains uncertain. Thus, the primary goal of this study was to assess the available evidence showing the efficacy of combination therapy in nonresponders by performing a systematic review of the literature with a meta-analysis of controlled trials.8

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Section: Discussionmentioning

confidence: 99%

“…21,24 (I) Uncontrolled and preliminary controlled trials with treatment duration Ն48 weeks (784 patients). 31,39,41,43,44,55,[58][59][60]70,72,77,[79][80][81]85,87 The dashed line represents the SVR for the randomized controlled trials used in the primary metaanalysis (A).…”

Section: Discussionmentioning

confidence: 99%

Interferon and ribavirin for patients with chronic hepatitis C who did not respond to previous interferon therapy: A meta-analysis of controlled and uncontrolled trials

Cheng

2001

Hepatology

101

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“…Dado que no existe una vacuna activa frente al VHC y que la profilaxis post-exposición con gammaglobulina no es eficaz, la única posibilidad terapéutica una vez detectada la infección es el tratamiento con antivirales. En la actualidad, este tratamiento debe efectuarse con la combinación de (18); que ofrece una respuesta sostenida en aproximadamente el 40% de los casos (9)(10)(11)(12)(13)(14)18). Al elevado número de pacientes no respondedores se unen los pacientes no tratados, que en muchos casos constituyen cerca del 50% de los pacientes conocidos infectados por el virus de la hepatitis C. El objetivo fundamental de este trabajo ha sido analizar los motivos por los que este amplio grupo de enfermos con antecedentes de uso de drogas por vía parenteral y diagnosticados de una hepatitis crónica por el VHC no son sometidos a tratamiento antiviral.…”

Section: Discussionunclassified

“…Por esta razón, este colectivo de pacientes constituye una de las dianas en el control de la infección por el VHC. La terapéutica frente al VHC está basada en la combinación de interferón alfa y ribavirina que induce, en las mejores series, una tasa de respuesta sostenida cercana al 40% en pacientes no tratados previamente, del 10 al 20% en pacientes que no respondieron con anterioridad a la monoterapia con interferón y del 60-70% en pacientes con recaídas (positivización espontánea de la viremia después de un periodo de negativización más o menos prolongado) tras el tratamiento previo con interferón (9)(10)(11)(12)(13)(14); además, esta relativamente baja tasa de respuesta sostenida solo se alcanza en grupos altamente seleccionados y a costa de un número no despreciable de efectos secundarios y de deterioro de la calidad de vida durante la administración del tratamiento (15). Por lo tanto, el tratamiento actual de las hepatopatías relacionadas con el VHC está lejos de ser ideal, ya que consigue la curación de un número relativamente bajo de pacientes, solo está indicado en algunos subgrupos de pacientes, es caro, es relativamente difícil de administrar y de elevado coste (16,17,18).…”

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“…Se han publicado cientos de ensayos analizando los regímenes terapéuticos más eficaces (9)(10)(11)(12)(13)(14), pero son mínimos los trabajos donde se recogen de forma sistemática las características clínicas de los pacientes no sometidos a tratamiento antiviral y las causas para no iniciar éste. Por este motivo, los objetivos de este trabajo han sido: 1) Analizar las características demográficas, clínicas e histológicas de los pacientes usuarios de drogas por vía parenteral diagnosticados de una hepatopatía relacionada con el VHC que no han sido sometidos a tratamiento antiviral y, 2) investigar los motivos por los que dicho tratamiento no fue realizado en una serie consecutiva de pacientes referidos a las consultas externas de nuestro Servicio durante un periodo de 10 años.…”

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Hepatitis crónica por VHC en la población usuaria de drogas por vía parenteral. Motivos para no iniciar el tratamiento antiviral

Crespo¹,

García

Castro

et al. 2001

Adicciones

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Aims:To analyse the prevalence of intravenous drug users (IDU) with chronic liver disease associated with hepatitis C virus (HCV) not undergoing antiviral treatment and the reasons for which this treatment was not indicated.Patients: 1269 patients with HCV infection referred for therapeutic evaluation between January 1990 and January 2000. 416 patients (32,7%) were IDU.Methods: Demographic, clinical, biological and histological variables were prospectively analysed. The IDU patients were divided into two groups: treated and untreated.Results: In the IDU group of patients, 268 were treated and in 148 (35,5%) patients antiviral treatment was not considered to be indicated. The most frequent reasons for not starting therapy were active intravenous drug use, the patients' refusal to undergo antiviral treatment and the presence of severe associated pathology.Conclusions: A broad subgroup of IDU patients with chronic liver disease associated with HCV do not receive antiviral treatment.

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¿Por qué no reciben tratamiento todos los pacientes con una hepatopatía crónica relacionada con el virus de la hepatitis C?

Crespo

Miguel

Pajares

et al. 2001

Gastroenterología y Hepatología

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Interferon alfa‐2b plus ribavirin for chronic hepatitis C patients who have not responded to interferon monotherapy

Abstract: Combination therapy with interferon plus ribavirin produced a sustained response in 16% of chronic hepatitis C patients who were non-responders to interferon. This combination was safe and well tolerated.

Cited by 18 publications

References 28 publications

Interferon and ribavirin for patients with chronic hepatitis C who did not respond to previous interferon therapy: A meta-analysis of controlled and uncontrolled trials

Interferon and ribavirin for patients with chronic hepatitis C who did not respond to previous interferon therapy: A meta-analysis of controlled and uncontrolled trials

Hepatitis crónica por VHC en la población usuaria de drogas por vía parenteral. Motivos para no iniciar el tratamiento antiviral

¿Por qué no reciben tratamiento todos los pacientes con una hepatopatía crónica relacionada con el virus de la hepatitis C?

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