Reuters Health Information (2004-07-05): High-dose interferon alpha provides lasting benefit in chronic hepatitis D
High-dose interferon alpha provides lasting benefit in chronic hepatitis D
Last Updated: 2004-07-05 10:00:02 -0400 (Reuters Health)
NEW YORK (Reuters Health) - For patients with chronic
hepatitis D, high-dose interferon alpha offers the best chance of
long-term survival, even among those who have cirrhosis before
treatment is initiated, results of a long-term follow up study indicate.
Researchers followed 36 patients with chronic hepatitis D who were
treated in the early 1990s with a 48-week course of either high-dose (9
million units) or low-dose (3 million units) interferon alpha or with
no therapy for an additional 2 to 14 years.
"A beneficial effect of high doses of interferon was already evident
at the end of the treatment period, with disappearance of signs of
liver damage in a significant proportion and a slowly progressive
decrease of virus replication," Dr. Patrizia Farci from the University
of Cagliari in Italy told Reuters Health.
During follow up, patients in the high dose interferon-alpha group
survived significantly longer than patients in the low-dose interferon
alpha (p = 0.019) or untreated control group (p = 0.003). Survival did
not differ between untreated controls and those treated with low-dose
"It is remarkable," the team notes in the June issue of
Gastroenterology, "that half the patients who had a biochemical
response at the end of treatment with 9 million units of interferon
(for 48 weeks) continued to have normal ALT for up to 14 years after
the termination of therapy."
"Interestingly," they write, all patients who had persistently
normal ALT levels had a decline in antibody titer and ultimately lost
serum IgM antibody to hepatitis delta antigen, "which is considered to
be the best marker of resolution of disease activity." The "sustained
decrease" in HDV replication in the high dose group led to clearance of
HDV RNA and eventually hepatitis B virus in some patients.
"But the most striking finding was obtained from the liver histology
study," Dr. Farci told Reuters Health. "Several patients treated with
interferon at the high dose showed a complete regression of liver
fibrosis, which is the major histopathological change underlying liver
cirrhosis, resulting in a normal-appearing liver tissue."
"Our study rebuts the dogma that cirrhosis is an irreversible process," Dr. Farci said.
According to Dr. Farci, the clinical, virological, and
histopathological findings in this study "clearly demonstrate that
treatment with high doses of interferon can dramatically change the
natural history of chronic hepatitis D, the most severe form of chronic