Reuters Health Information (2008-02-29): Interferon is effective in hemodialysis patients with hepatitis C
Interferon is effective in hemodialysis patients with hepatitis C
Last Updated: 2008-02-29 15:57:06 -0400 (Reuters Health)
NEW YORK (Reuters Health) - A paper in the February issue of the American Journal of Kidney Diseases suggests that in hemodialysis patients with hepatitis C virus (HCV) infection, interferon (IFN) therapy achieves good rates of sustained virological response.
Dr. Craig E. Gordon and colleagues at Tufts-New England Medical Center in Boston conducted a meta-analysis and meta-regression of randomized controlled trials, uncontrolled trials, and prospective observational studies in order to assess the risks and benefits of using IFN and pegylated IFN (PEG-IFN), with and without ribavirin, to treat hemodialysis patients who have chronic HCV infection. To be included, studies had to report on virological response at least 5 months after treatment.
The studies included 20 in which a total of 459 patients were given IFN, 3 in which 38 patients were treated with PEG-IFN, and 2 in which 49 patients received PEG-IFN and ribavirin.
Overall in the 25 studies, the sustained viral response to IFN was 41%. For PEG-IFN, the overall sustained viral response was 37%. The authors report that viral response rates were higher when the dose of IFN was at least 3 million units. Sustained viral response was also higher with lower mean HCV RNA levels and with lower rates of cirrhosis, HCV genotype 1 or elevated transaminase, but not to a statistically significant degree.
Frequently reported adverse events included influenza-like illness, anemia, symptomatic rejection of a nonfunctioning kidney graft, depression, leukopenia, confusion, diarrhea, thrombocytopenia, and seizures. Combined treatment discontinuation rates were 26% for IFN and 28% for PEG-IFN.
"The sustained virological response of 41% to interferon in dialysis patients is nearly as high as that seen with pegylated-interferon and ribavirin combination therapy in the general population of patients who are not on dialysis," Dr. Gordon said in an interview with Reuters Health. "This is important because dialysis patients cannot receive ribavirin because of a high rate of side effects," he explained. "We think the higher response to interferon is because of fixed dosage in patients with impaired kidney function resulting in higher drug levels leading to greater efficacy but also a higher rate of side effects, although this is not yet proven."
"Most physicians would expect that the treatment of hepatitis C virus would be less successful in hemodialysis patients," Dr. Gordon said. "We found the opposite, and in fact the treatment was more successful in hemodialysis patients, suggesting that perhaps more patients should be considered for treatment."
The author noted that there is a high risk of side effects from interferon, so patients need to be selected carefully. "For instance, hemodialysis patients with untreated depression would not be good candidates for treatment because interferon can worse depression," he said. "So there are several reasons to be cautious with treatment," he added.
Am J Kidney Dis 2008;51:263-277.