Interferon alpha for chronic hepatitis D

Abbas, Zaigham; Khan, Muhammad Arsalan; Salih, Mohammad; Jafri, Wasim

doi:10.1002/14651858.cd006002.pub2

Cited by 35 publications

(26 citation statements)

References 64 publications

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“…In addition, subjects with Ishak 6 (equivalent to METAVIR 4 fibrosis stage) would utilize additional healthcare including variceal screening . Given that interferon‐based therapies result in sustained loss of HDV RNA in only 20–30% of patients, and is currently the only recommended therapy for this devastating disease, it is important to identify patients who would be eligible candidates and worth treating . The utility of these biomarkers, or improved ones, that utilize simple routine tests could play a significant clinical role in identifying individuals who could be worth the gamble of interferon‐based therapy, especially in countries without advanced medical capabilities.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive markers for staging fibrosis in chronic delta hepatitis

Takyar

Surana

Kleiner

et al. 2016

Aliment Pharmacol Ther

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Background Serum fibrosis markers are useful in staging chronic hepatitis B (HBV) and C (HCV) but have not been evaluated in chronic hepatitis D (HDV). Aims We evaluated the utility of serum fibrosis markers (fibrosis-4 score [FIB-4], AST to ALT ratio [AAR], age-platelet index [API], AST-to-platelet-ratio-index [APRI] and Hui score) in HDV infection. Methods Clinical and histologic laboratory data from HBV, HCV and HDV patients were evaluated and serum fibrosis markers were calculated. The ability of fibrosis markers to detect advanced fibrosis (Ishak ≥4) and cirrhosis (Ishak =6) were evaluated and compared between viral infections. Results 1003 subjects (HCV=701, HBV=240 and HDV=62) with mean age of 46 ±11 and 66% male were evaluated. HDV subjects had higher ALT and AST than HCV and lower platelets than both HBV and HCV. Histologically, HDV had the greatest percentage of Ishak≥4 and necroinflammation. FIB-4 performed best in detecting advanced fibrosis and cirrhosis in all viral cohorts. In HDV, area under the receiver operator curve (AUROC) 95% confidence intervals for detecting advanced fibrosis were: FIB-4=0.70 (0.55–0.84), API=0.69 (0.55–0.82), APRI=0.68 (0.54–0.82), Hui score=0.63 (0.49–0.78), AAR=0.63 (0.48–0.77). The AUROC for detecting cirrhosis in HDV were: FIB-4=0.83(0.69–0.97), API=0.80(0.66–0.95), APRI=0.75(0.61–0.89), Hui score=0.70(0.49–0.91) and AAR=0.70(0.48–0.93). Adjustment of published cut-offs led to marginal improvements in FIB4 for advanced fibrosis and of APRI for cirrhosis in HDV. Conclusions Serum fibrosis markers have lower performance accuracy in chronic HDV infected patients compared to HBV and HCV patients. Other noninvasive fibrosis markers should be explored to assist in the management of these patients.

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Section: Discussionmentioning

confidence: 99%

Noninvasive markers for staging fibrosis in chronic delta hepatitis

Takyar

Surana

Kleiner

et al. 2016

Aliment Pharmacol Ther

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“…Inclusion criteria were age 1560 years, antiHDV anti body positive and detectable serum HDV RNA at enrolment by real time polymerase chain reaction (PCR), elevated alanine aminotransferase (ALT) on two occasions in last 3 mo during screening phase, patients with compensated liver disease, i.e., Child Pugh class A, hemoglobin > 12.0 g/dL for males and > 11.0 g/dL for females at screening, total leucocyte count > 3.000/mm 3 , and neutrophils > 1500/mm 3 , platelets > 80.000/mm 3 , serum creatinine level < 1.5 mg/dL and liver biopsy within 6 mo prior to randomization.…”

Section: Participantsmentioning

confidence: 99%

“…Standard interferonalfa is not an ideal treatment [3] . Recent few trials with pegylated interferon alfa (PEG IFNα) have shown a better response of 25%30% six months post treatment [4,5] .…”

Section: Introductionmentioning

confidence: 99%

Co-treatment with pegylated interferon alfa-2a and entecavir for hepatitis D: A randomized trial

Abbas

Memon

Umer

et al. 2016

WJH

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AIM:To investigate the efficacy of pegylated interferon alfa (PEG-IFNα) therapy with and without entecavir in patients with chronic hepatitis D. METHODS:Forty hepatitis D virus (HDV) RNA positive patients were randomized to receive either PEG-IFNα-2a 180 µg weekly in combination with entecavir 0.5 mg daily (n = 21) or PEG-IFNα alone (n =19). Patients who failed to show 2 log reduction in HDV RNA level at 24 wk of treatment, or had detectable HDV RNA at 48 wk of therapy were considered as treatment failure. Treatment was continued for 72 wk in the rest of the patients. All the patients were followed for 24 wk post treatment. Intention to treat analysis was performed. RESULTS:The mean age of the patients was 26.7 ± 6.8 years, 31 were male. Two log reduction in HDV RNA levels at 24 wk of therapy was achieved in 9 (43%) patients receiving combination therapy and 12 (63%) patients receiving PEG-IFNα alone (P = 0.199). Decline in hepatitis B surface antigen (HBsAg) levels was insignificant. At the end of treatment, HDV RNA was negative in 8 patients (38%) receiving combination Co-treatment with pegylated interferon alfa-2a and entecavir for hepatitis D: a randomized trial Randomized Clinical Trial ORIGINAL ARTICLEtherapy and 10 patients (53%) receiving PEG-IFNα-2a alone. Virological response persisted in 7 (33%) and 8 (42%) patients, respectively at the end of the 24 wk follow-up period. One responder patient in the combination arm lost HBsAg and became hepatitis B surface antibody positive. Six out of 14 baseline hepatitis B e antigen reactive patients seroconverted and four of these seroconverted patients had persistent HDV RNA clearance. CONCLUSION:Administration of PEG-IFNα-2a with or without entecavir, resulted in persistent HDV RNA clearance in 37% of patients. The addition of entecavir did not improve the overall response.

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“…Interferon, standard or pegylated, is the only treatment option available to hepatitis D patients. Peg-IFN for hepatitis D is of limited efficacy [8,9] and the addition of a nucleoside analog does not improve the response [10]. The agent seems effective in suppressing viral and liver disease activity in some patients, but this improvement is not sustained in the majority of patients.…”

Section: Introductionmentioning

confidence: 99%