Long-term benefit of interferon α therapy of chronic hepatitis D: regression of advanced hepatic fibrosis

Farci, Patrizia; Roskams, Tania; Chessa, Luchino; Peddis, Giovanna; Mazzoleni, Anna Paola; Scioscia, Rosetta; Serra, Giancarlo; Lai, Maria Eliana; Loy, M.; Caruso, L; Desmet, Valeer; Purcell, Robert H.; Balestrieri, A

doi:10.1053/j.gastro.2004.03.017

Cited by 268 publications

(224 citation statements)

References 30 publications

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“…The therapeutic efficacy increases when higher doses of IFN-a (9 MU tiw) are administered for prolonged periods (12-24 months). Improvement in clinical outcome and survival has been reported by Farci et al [44], even in patients with cirrhosis at baseline. Castelnau et al [45] recently reported a study using pegylated IFN-a-2b to treat 14 chronic hepatitis D patients for 12 months.…”

Section: Standard or Pegylated Ifn Monotherapymentioning

confidence: 62%

“…Although treatment is not yet satisfactory, a proportion of patients with chronic hepatitis D benefit form IFN-a treatment, There are five relatively small randomized controlled clinical trials using IFN monotherapy in patients with chronic hepatitis D with a variable dosing (from 3 to 9 MU) and different treatment periods (from 3 to 24 months) ( Table 3). The response is limited and variable depending on the different schedules of treatment [39][40][41][42][43][44][45]. Up to 70% of patients may reach a normal aminotransferase level while on treatment, but the relapse rate is high after discontinuation.…”

Section: Standard or Pegylated Ifn Monotherapymentioning

confidence: 99%

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Current therapy for hepatitis C or D or immunodeficiency virus concurrent infection with chronic hepatitis B

Chien

2008

Hepatol Int

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Concurrent hepatitis C virus (HCV), hepatitis delta virus (HDV), or human immunodeficiency virus (HIV) infection with chronic hepatitis B virus (HBV) appears to increase the risk of progressive liver disease including liver cirrhosis and hepatocellular carcinoma. There is a 10% prevalence of HCV infection in chronic HBV or HDV infection. Serological evidence of previous exposure to HBV is found in more than 80% of HIVpositive patients in the high risk group. Notably, the most recently acquired virus tends to suppress the pre-existing virus. In chronic HBV infection acquired perinatally or in early childhood, usually HCV is dominant and may suppress or even displace HBV and HDV. Less frequently, HBV or HDV suppresses HCV. It is generally agreed that the dominant virus should be identified in order to make appropriate treatment decisions. Studies with standard interferon (IFN) to treat patients with HCV dominantly dual HBV/HCV infection have showed only limited virological response. But high dose of IFN has been demonstrated with better response rate. Combined ribavirin with standard or pegylated IFN therapy could achieve a sustained HCV clearance rate comparable with those infected with HCV alone. On the contrary, patients with HBV dominantly dual viral infection might indicate more appropriate addition of lamivudine to IFN than ribavirin. Additionally, patients with concurrent infection of HBV and HDV, IFN seems to be the only effective agent. However, the efficacy of IFN is related to the dose. High dose of IFN [9 MU tiw (thrice per week)] and longer treatment duration (at least 2 years) have been shown to achieve adequate virological response. In patients with concurrently infected HBV and HIV, anti-HBV therapy should be considered for all patients with evidence of liver disease, irrespective of the CD4 cell count. In patients not requiring antiretroviral therapy, HBV therapy should be preferentially based on IFN, adefovir, or telbivudine. In contrast, in patients with CD4 cell counts \350 cells/ll or those already on antiretroviral therapy, agents with double anti-HBV and anti-HIV activity are preferred. At present, the evidence of therapeutic efficacy is not sufficient to make a recommendation in treating patients with dual HBV/HCV or HBV/HDV or HBV/HIV infection. Further studies of the well-designed, larger scale are needed to elucidate the role of different regimens or combination in the treatment of dual viral infection.

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Section: Standard or Pegylated Ifn Monotherapymentioning

confidence: 62%

Section: Standard or Pegylated Ifn Monotherapymentioning

confidence: 99%

Current therapy for hepatitis C or D or immunodeficiency virus concurrent infection with chronic hepatitis B

Chien

2008

Hepatol Int

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“…Thus, it is uncertain whether not detecting HDV RNA 6 months after .therapy in the presence of hepatitis B surface antigen (HBsAg) does in fact indicate a change in the natural history of chronic hepatitis D represents an ephemeral event with no long-term clinical effects. Only anecdotal reports exist of long-term clinical ameliorations after treatment with IFN 9 and longitudinal retrospective surveys of previously treated patients are needed to establish the true clinical value of the current IFN therapy in patients with chronic hepatitis D.…”

mentioning

confidence: 99%

PEG-IFN for the treatment of hepatitis D

Ciancio

Rizzetto

2011

Nat Rev Gastroenterol Hepatol

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“…High doses of IFN␣ significantly improved the long-term clinical outcome and survival of patients with chronic hepatitis D even though the majority had active cirrhosis before treatment. 19 However, the therapy of chronic hepatitis D is not yet satisfactory. Several strategies have been explored to improve the efficacy of IFN␣, including longer duration of treatment or even continuous therapy for up to 12 years, 20 but most of the patients still failed to clear HDV and the rate of relapse remains high.…”

mentioning

confidence: 99%

“…19,28 However, HDV RNA detection still relies on home-made assays, and it is urgent to develop standardized PCR assays for the detection and quantification of HDV viremia. Castelnau et al show that HDV RNA quantification identifies patients with an early virological response as well as those with a late decrease in viremia, who might benefit from a more prolonged course of therapy.…”

mentioning

confidence: 99%