Outcome of Double-Filtration Plasmapheresis plus Interferon Treatment in Nonresponders to Pegylated Interferon plus Ribavirin Combination Therapy

Abstract

Objectives: We assessed the outcome of double-filtration plasmapheresis (DFPP) combined with pegylated interferon (PEG-IFN) and ribavirin (RBV) therapy in patients infected with hepatitis C virus (HCV)-1b whose HCV had not disappeared during PEG-IFN/RBV combination therapy, or who had relapsed after the end of the therapy. Additionally, we investigated factors predictive of sustained virological response (SVR), including host and viral genetic factors, to DFPP plus IFN/RBV therapy. Methods: A total of 40 patients infected with HCV-1b whose HCV virus had not been eradicated by previous PEG-IFN/RBV therapy were enrolled for treatment by DFPP plus IFN/RBV. Rapid virological response (RVR) and SVR were assessed, and pretreatment factors associated with SVR - the interleukin (IL)28B gene, the IFN/RBV resistance-determining region (IRRDR) and the IFN sensitivity-determining region (ISDR) - were analyzed. Results: Of the 40 patients, 9 (23%) achieved RVR and 10 (25%) achieved SVR. The significant factors associated with SVR were IL28B major and RVR,as assessed by multivariate analysis (p = 0.0182, p = 0.0005). Conclusion: Patients whose HCV is not eradicated by previous PEG-IFN/RBV would be good candidates for combined DFPP and IFN/RBV retreatment provided they demonstrate IL28B major and have achieved RVR.

Liver Support With Albumin Dialysis Reduces Hepatitis C Virus Viremia and Facilitates Antiviral Treatment of Severe Hepatitis C Virus Recurrence After Liver Transplantation

“…One hundred and seventy patients with HCV‐related liver disease were transplanted in our center between 2005 and 2013. Thirteen Caucasian patients (48 years [45–62], 11 males) presenting a diagnosis of fibrosing cholestatic hepatitis ( N = 8) or severe conventional HCV recurrence ( N = 5, HVPG: 11.5 mm Hg ) were enrolled into the MARS salvage protocol (Table ). They had similar demographic and laboratory characteristics at baseline (Supplementary Table 1).…”

“…Patients received the MARS treatment at a median of 3 months after LT. Two patients with HCV viral load above the upper limit of detection before and after MARS treatment were excluded from the analysis of viral kinetics. The 3‐day MARS treatment induced decreases of HCV viral load in all the remaining patients (7.59 log 10 IU/mL [6.15–8.90] to 6.79 log 10 IU/mL [5.18–7.84], P = 0.003, Fig.…”

“…Dialysis procedures have been shown to reduce HCV RNA in the blood of infected individuals . Interestingly, their combination with Peg‐IFN and ribavirin treatment has been associated with slow progression of fibrosis and high SVR rates in HCV patients with and without end‐stage renal disease. Early initiation of double filtration plasmapheresis has also been reported to improve the outcome of patients with HCV recurrence after LT .…”

Strategies to Preclude Hepatitis C Virus Entry

“…Patients who underwent the prophylactic combination treatment of low-dose IFN, ribavirin, and DFPP had no evidence of HCV recurrence or fibrosing cholestatic hepatitis exacerbation for more than 1 year after liver transplantation [180]. Combination of DFPP and IFN also achieved impressive SVR in difficult-to-treat patients (i.e., relapsed, nonresponder, or HIVcoinfected patients) [181][182][183][184] and may also be safe for the elderly population [185]. However, the approach of apheresis for decreasing HCV viral load requires specialty equipment and possesses potential risk of adverse events (e.g., blood pressure lowering, puncture site hematoma, or infection) [181,185].…”

Chronic Liver Diseases and Hepatocellular Carcinoma: An Update for 2013

“…Sugimoto et al [5] reported that double-filtration plasmapheresis plus IFN treatment in nonresponders to pegylated IFN plus RBV combination therapy in patients with a high viral load of hepatitis C genotype 1b achieved SVR in 15% (10/40) of patients, which represents a relatively good result. The significant factors associated with SVR were interleukin-28B major type and a rapid virological response at week 4.…”