Treatment of chronic hepatitis delta virus with peg-interferon and factors that predict sustained viral response

Devrajani, Bikharam; Nasreen,

doi:10.3748/wjg.v18.i40.5793

Cited by 14 publications

(6 citation statements)

References 16 publications

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“…The maintained VR rate achieved in our study corresponds to other studies that have evaluated peginterferon therapy for HDV with rates ranging from 17% to 43% after 24 weeks of therapy, 21-48% with therapy ranging from 48 to 96 weeks. [25][26][27][28][29][30][31][32] Similar to a recent publication, there has been no evidence of relapse of our patients who achieved a CVR, some of which have been followed up to 246 weeks after stopping therapy. 33 Interestingly, two of the four patients achieved a CVR prior to the completing 1 year of therapy (weeks 24 and 37) and the other one at week 202.…”

Section: Discussionsupporting

confidence: 87%

Long-term therapy of chronic delta hepatitis with peginterferon alfa

Heller

Rotman

Koh

et al. 2014

Aliment Pharmacol Ther

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Background Chronic delta hepatitis (HDV) infection rapidly progresses to cirrhosis. Treatment with peginterferon for up to 2 years is often without durable response. Aim We examined the efficacy and safety of long-term peginterferon in achieving a durable response. Methods Treatment was initiated with 180 μg/wk of peginterferon alfa-2a with titration to a maximal tolerable dose, for up to 5 years. Liver biopsies and hepatic venous pressure gradients (HVPG) were evaluated at baseline, 1, 3, and 5 years. The primary endpoint was histological improvement or loss of serum HDV and HBsAg at 3 years. Results 13 patients were treated for a median of 140 weeks (6–260) with an average peginterferon dose of 180 μg/wk (90–270). At baseline, most had advanced disease (median Ishak fibrosis = 3) with portal hypertension (HVPG = 10.2 +/− 6 mm Hg). 5 of 13 patients (39%) achieved the primary endpoint, with 3 seroconverting for HBsAg after 24, 37 and 202 weeks of treatment. Histologic inflammation improved after one year, (median HAI: 10 vs. 7, p=0.01) with persistence in 4/5 patients at 3 years (median HAI: 7.5). Greatest improvements occurred in the first year. Baseline bilirubin and HBsAg levels were significantly lower in virologic responders than non-responders. After 12 weeks, virologic responders had a significant decline in HBsAg (1.5 log10 IU/mL, p=0.05). Conclusion Despite increased doses and duration of therapy, treatment of chronic HDV with peginterferon remains unsatisfactory. Quantitative measures of HBsAg may be an important biomarker of early response to peginterferon therapy in chronic HDV infection.

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Section: Discussionsupporting

confidence: 87%

Long-term therapy of chronic delta hepatitis with peginterferon alfa

Heller

Rotman

Koh

et al. 2014

Aliment Pharmacol Ther

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“…They found a virological response rate of 50% and persistent virological response rate of 47% at the end of treatment with Peg IFN α 2a (180 mcg) and α 2b (1.5 mcg/kg) for 24 months in 32 patients with chronic hepatitis Delta. Hepatitis Delta prevalence is high in Pakistan and in a study conducted there, persistent virological response was 29.4% in 238 of 277 patients who completed the study and treated with Peg IFN α 2a for 48 months ( 22 ). In many studies and in our study as well, persistent HDV RNA negativity occurred at a rate of 30%.…”

Section: Discussionmentioning

confidence: 99%

“…The fact that the rate of cirrhosis was higher in patients receiving Peg IFN α 2b may be a factor affecting the response to treatment (53.3% vs. 34.1%). Samiullah et al ( 22 ) found that significant positive response was a predictor of lower stage of fibrosis. Furthermore, the fact that viral load was lower in the group of Peg IFN α 2b may be explained by higher cirrhosis rate in this group.…”

Section: Discussionmentioning

confidence: 99%

Pegylated Interferon α Therapy in Chronic Delta Hepatitis: A One-Center Experience

et al. 2015

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Background:The only established therapy for chronic viral delta hepatitis, the most severe form of viral hepatitis is treatment with pegylated-interferon α (Peg IFN α).Objectives:In this study, we aimed to determine the efficacy of pegylated-interferon α 2a (Peg-IFN α 2a) and 2b (Peg IFN α 2b) in the treatment of patients infected with chronic delta hepatitis virus.Patients and Methods:The sample size was based on available patients potentially to be recruited. Data of 63 patients receiving either Peg IFN alpha 2a or Peg IFN alpha 2b were retrospectively assessed in the present cohort study performed in Turkey. Of 56 patients completed the study, 41 received Peg IFN α 2a and 15 received Peg IFN α 2b for 12 months. Patients were evaluated for biochemical and virological responses at the end of given treatment and six months after the treatment.Results:Stage of fibrosis was found high in both groups (85.4% vs. 86.7%), while cirrhosis was higher in the group of Peg IFN α 2b (53.3% vs. 34.1%). At the end of treatment, either hepatitis delta virus RNA (HDV RNA) alone or both HDV RNA and hepatitis b virus DNA (HBV DNA) had negative results in 32% of patients. Although HDV RNA negativity was sustained in 30.3% of patients, negativity of both HDV RNA and HBV DNA was decreased to 19.6% six months after completion of the treatment. HBV DNA became positive in one third of patients with response at six months after completion of the treatment (10.7% of all patients). HDV RNA negativity at month six was found as a predictor of positive response. No significant difference was found between Peg IFN α 2a and Peg IFN α 2b for virological response rate.Conclusions:Treatment with Peg IFN α achieved a sustained negativity of HDV RNA in about one third of patients. Duration of Peg IFN α therapy might be prolonged to at least 24 months or more to prevent the occurrence of Hepatitis B virus (HBV) relapse encountered six months after completion of the treatment.

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“…In patients with decompensated cirrhosis, the use of interferon is contraindicated, but in patients with compensated cirrhosis, peg-interferon was effective [ 127 ].…”

Section: Treatmentmentioning

confidence: 99%

Hepatitis delta: virological and clinical aspects

Souza

Vasconcelos

Santos

et al. 2017

Virol J

107

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There are an estimated 400 million chronic carriers of HBV worldwide; between 15 and 20 million have serological evidence of exposure to HDV. Traditionally, regions with high rates of endemicity are central and northern Africa, the Amazon Basin, eastern Europe and the Mediterranean, the Middle East and parts of Asia. There are two types of HDV/HBV infection which are differentiated by the previous status infection by HBV for the individual. Individuals with acute HBV infection contaminated by HDV is an HDV/HBV co-infection, while individuals with chronic HBV infection contaminated by HDV represent an HDV/HBV super-infection. The appropriate treatment for chronic hepatitis delta is still widely discussed since it does not have an effective drug. Alpha interferon is currently the only licensed therapy for the treatment of chronic hepatitis D. The most widely used drug is pegylated interferon but only approximately 25% of patients maintain a sustained viral response after 1 year of treatment. The best marker of therapeutic success would be the clearance of HBsAg, but this data is rare in clinical practice. Therefore, the best way to predict a sustained virologic response is the maintenance of undetectable HDV RNA levels.

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Treatment of chronic hepatitis delta virus with peg-interferon and factors that predict sustained viral response

Abstract: Peg-interferon therapy can induce remission in nearly one third of patients harboring HDV.

Cited by 14 publications

References 16 publications

Long-term therapy of chronic delta hepatitis with peginterferon alfa

Long-term therapy of chronic delta hepatitis with peginterferon alfa

Pegylated Interferon α Therapy in Chronic Delta Hepatitis: A One-Center Experience

Hepatitis delta: virological and clinical aspects

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