Interferon-α 2b plus ribavirin in patients with chronic hepatitis C after liver transplantation: A randomized study

Samuel, Didier; Bizollon, T.; Féray, Cyrille; Roche, Bruno; Ahmed, Si Nafa Si; Lemonnier, Catherine; Cohard, Marielle; Reynès, M; Chevallier, Marie; Ducerf, C.; Baulieux, J.; Geffner, Michael; Albrecht, Janice K.; Bismuth, H; Trépo, C.

doi:10.1053/gast.2003.50095

Cited by 325 publications

(315 citation statements)

References 34 publications

Supporting

Mentioning

287

Contrasting

Unclassified

Order By: Relevance

“…The response rate to antiviral therapy with Peg-IFNa with or without RBV is lower in the transplant population. [74][75][76] Also post-transplant patients have relatively more side effects and poor tolerance to combination antivirals. The arrival of DAA allows IFNa-free treatment regimen in HCV-infected liver transplant recipients (LTR).…”

Section: Management Of Hcv Infection After Liver Transplant (Lt)mentioning

confidence: 99%

Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016

Puri

Saraswat

Dhiman

et al. 2016

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

India contributes significantly to the global burden of HCV. While the nucleoside NS5B inhibitor sofosbuvir became available in the Indian market in March 2015, the other directly acting agents (DAAs), Ledipasvir and Daclatasvir, have only recently become available in the India. The introduction of these DAA in India at a relatively affordable price has led to great optimism about prospects of cure for these patients as not only will they provide higher efficacy, but combination DAAs as all-oral regimen will result in lower side effects than were seen with pegylated interferon alfa and ribavirin therapy. Availability of these newer DAAs has necessitated revision of INASL guidelines for the treatment of HCV published in 2015. Current considerations for the treatment of HCV in India include the poorer response of genotype 3, nonavailability of many of the DAAs recommended by other guidelines and the cost of therapy. The availability of combination DAA therapy has simplified therapy of HCV with decreased reliance of evaluation for monitoring viral kinetics or drug related side effects. ( J CLIN EXP HEPATOL 2016;6:119-145) T here have been revolutionary changes in the management of chronic hepatitis C (CH-C) over the last few years. Pegylated interferon alfa (Peg-IFNa) plus ribavirin (RBV) therapy, which till the recent past was the standard of care, has been eclipsed by the arrival of newer directly acting antiviral agents (DAAs). Not only do the DAAs have better efficacy, they are also associated with lower side effects, have better tolerability, a shorter duration of therapy, and have simpler administration.In the recent guidelines issued by the American Association for the study of Liver Diseases (AASLD), in collaboration with the Infectious Diseases Society of America 1 and the European Association for Study of the Liver z (EASL), 2 the role of Peg-IFNa/RBV therapy in the management of HCV has been relegated to second-line, backup status. These newer guidelines, however, cannot be implemented in India as many of the recommended drugs are yet to be marketed in India. Other considerations for the treatment of HCV in India are a predominance of

show abstract

Section: Management Of Hcv Infection After Liver Transplant (Lt)mentioning

confidence: 99%

Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016

Puri

Saraswat

Dhiman

et al. 2016

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

show abstract

“…9,10,12 While still suboptimal, these rates of SVR are somewhat higher than those observed with the standard interferon and RBV combination therapy (ϳ20%) or those with pegylated interferon monotherapy (ϳ10%). [5][6][7] The lower rate of SVR compared to nontransplant HCV patients can be attributed to several factors including differences in the HCV dynamics between the immunocompetent and immunocompromised hosts, 20,21 higher prevalence of insulin resistance in LT recipients, and lower tolerability of PEG/RBV. 22,23 Consistent with the treatment of chronic nontransplantation HCV infection, genotypes other than 1 were associated with a significantly higher rate of SVR.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] The introduction of pegylated interferon alfa (PEG) therapy in combination with RBV therapy (PEG/RBV) significantly improved the antiviral response rate in chronic HCV patients, although data from liver transplant recipients is limited. To date, there have been 10 published studies that enrolled greater than 20 patients each to evaluate the efficacy and safety of PEG/RBV combination therapy in LT patients with reported SVR rates ranging between 31% and 45%.…”

mentioning

confidence: 99%

Recurrent hepatitis C after liver transplantation: On-treatment prediction of response to peginterferon/ribavirin therapy

et al. 2007

View full text Add to dashboard Cite

Sustained virologic response (SVR) in the treatment of recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) remains suboptimal. We evaluated efficacy of pegylated interferon alfa (PEG) and ribavirin (RBV) (PEG/RBV) combination therapy in LT recipients with recurrent HCV and predictive values of rapid virological response (RVR) and early virologic response (EVR). Between January 2001 and October 2005, LT recipients with recurrent HCV were intended to be treated for 48 weeks with PEG/RBV combination therapy independent of genotype or virologic response [53 patients (79% genotype 1)]. On-treatment predictor of response at week 4 (RVR) was defined as undetectable HCV RNA, and at week 12 (EVR) as undetectable HCV RNA or a Ͼ2 log 10 drop from pretreatment viral load. SVR was seen in 19 (35%) patients. Patients with genotype 2/3 were more likely to achieve SVR than those with genotype 1 (87% versus 23%; P ϭ 0.001). The highest rate of SVR was seen in patients with RVR [specificity and positive predictive value (PPV) ϭ 100%] while the highest rate of treatment failure was seen in those who did not have EVR [sensitivity and negative predictive value (NPV) ϭ 100%]. The NPV of RVR to identify those who will not achieve SVR was also very high (88%). EVR had low PPV (63%) to identify those with SVR. In conclusion, PEG/RBV combination therapy is effective in the treatment of post-LT recurrent HCV. On-treatment virologic monitoring is highly predictive of SVR and may optimize the virologic response and minimize toxicity. Given its high PPV and NPV, RVR appears to be the most appropriate decision time point for continuation of therapy.

show abstract

“…3,8 In addition, assessment of liver damage is relevant to adopt therapeutic decisions, particularly because of the low efficacy and high incidence of adverse events of current antiviral therapy in this group of patients. 3,9,10 Sampling variability is a limitation of liver biopsy for the assessment of fibrosis. Needle biopsy specimens represent an extremely small part of the liver and for this reason sample errors are frequent.…”

Section: Hronic Hepatitis C Virus (Hcv) Infection Leadingmentioning

confidence: 99%

Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation

et al. 2006

View full text Add to dashboard Cite

Liver biopsy is essential in the follow-up of HCV-infected liver transplant recipients. The aim of this study was to prospectively compare percutaneous (PLB) versus transjugular liver biopsy (TLB) in the assessment of liver damage. We also explored the diagnostic value of hepatic venous pressure gradient (HVPG) to identify patients at risk of severe HCV disease recurrence after liver transplantation (LT). One hundred sixteen paired PLB and TLB (with HVPG measurement) were performed 3 or 12 months after LT in 80 patients. Concordance for necroinflammation and fibrosis was fair or good, particularly 1 year after LT (kappa > 0.6). At this point, a significant positive association was seen between the median HVPG and the fibrosis stage C hronic hepatitis C virus (HCV) infection leading to liver cirrhosis and hepatocellular carcinoma is the main indication for liver transplantation (LT) in Western countries and Japan. 1 Regretfully, recurrence of HCV infection is universal after LT, 2 and disease progression is significantly faster in immunosuppressed than in immunocompetent individuals. In liver transplant recipients, chronic HCV infection may lead to cirrhosis in as much as 30% of individuals only 5 years after LT. [3][4][5] Once liver cirrhosis is established, the cumulative probability of developing clinical decompensation is close to 50% 1 year after diagnosis and, more importantly, survival after decompensation is extremely short. 6 As a result of this accelerated course of HCV infection, longterm graft and patient survival are significantly reduced in patients undergoing LT for HCV-related cirrhosis compared with other groups. 7 Frequent liver biopsies are essential to monitor HCV-induced liver damage and are part of the routine follow-up of HCV-infected liver transplant recipients. Early histological damage after transplantation correlates with long-term outcome; in fact, the presence of significant liver fibrosis in 1-year liver biopsies identifies patients at high risk of graft loss. 3,8 In addition, assessment of liver damage is relevant to adopt therapeutic decisions, particularly because of the low efficacy and high incidence of adverse events of current antiviral therapy in this group of patients. 3,9,10

show abstract

Interferon-α 2b plus ribavirin in patients with chronic hepatitis C after liver transplantation: A randomized study

Cited by 325 publications

References 34 publications

Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016

Indian National Association for Study of the Liver (INASL) Guidance for Antiviral Therapy Against HCV Infection: Update 2016

Recurrent hepatitis C after liver transplantation: On-treatment prediction of response to peginterferon/ribavirin therapy

Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation

Contact Info

Product

Resources

About