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Efficacy of the retreatment of hepatitis C virus infections after liver transplantation: role of an aggressive approach.

Abstract
A sustained virological response (SVR) is achieved by 30% of naive liver transplantation (LT) recipients treated with pegylated interferon (PEG-IFN) and ribavirin (RBV). Almost no data are available about retreatment. The aim of this study was to assess the efficacy, tolerability, and SVR predictors of retreatment. Data were collected from 4 centers on the retreatment of prior nonresponders to standard therapy or PEG-IFN (with or without RBV) and relapsers. Seventy-nine of 301 treatment-experienced LT patients (26%), who had a median age of 59 years (range = 35-77 years) and were mostly male (72%) and infected with genotype 1 (87%), were retreated with PEG-IFN and RBV at a median of 6.9 years after LT. During the first course of therapy, 35% were treated with interferon, 49% received tacrolimus, 52% received steroids, and 49.5% were relapsers. Retreatment was started at a median of 1.9 years (range = 45 days to 8.2 years) after the end of the first course. The proportion of patients with cirrhosis increased from 10% to 37% (P < 0.001). In addition, in retreated patients, full initial RBV doses (P = 0.03), growth factors [erythropoietin (P < 0.001) and granulocyte colony-stimulating factor (P = 0.048)], and transfusions (P = 0.03) were used more frequently, and the treatment duration was longer (P = 0.03). An end-of-treatment response was achieved in 61%, whereas SVR, which was associated with improved survival, occurred in 28 (35%). The variables predicting SVR were age (P = 0.04), disease severity [fibrosis (50% with F0-F2 versus 26% with F3-4), P = 0.03; bilirubin, P = 0.006; platelet count, P = 0.03], adherence, and viral kinetics. None of the patients without an early virological response achieved SVR. There was a trend of prior relapsers achieving higher SVR rates than prior nonresponders. In conclusion, SVR, which was achieved by approximately one-third of the retreated patients, can be predicted with the same variables used for naive LT recipients (age, disease severity, adherence, and viral kinetics) and is associated with enhanced survival.
AuthorsMarina Berenguer, Bruno Roche, Victoria Aguilera, Jean-Charles Duclos-Vallée, Laia Navarro, Angel Rubín, Jose-Antonio Pons, Manuel de la Mata, Martín Prieto, Didier Samuel
JournalLiver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 19 Issue 1 Pg. 69-77 (Jan 2013) ISSN: 1527-6473 [Electronic] United States
PMID23008144 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2012 American Association for the Study of Liver Diseases.
Chemical References
  • Interferon-alpha
  • Recombinant Proteins
  • peginterferon alfa-2a
  • peginterferon alfa-2b
  • Polyethylene Glycols
  • Ribavirin
Topics
  • Adult
  • Aged
  • Female
  • Hepatitis C (drug therapy, mortality, virology)
  • Humans
  • Interferon-alpha (administration & dosage)
  • Liver Transplantation (adverse effects)
  • Male
  • Middle Aged
  • Polyethylene Glycols (administration & dosage)
  • Recombinant Proteins (administration & dosage)
  • Ribavirin (administration & dosage)

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