Clinical

Pegylated interferon alpha-2a advantageous in dialysis patients with hepatitis C

Last Updated: 2008-04-04 15:52:33 -0400 (Reuters Health)

By Scott Baltic

NEW YORK (Reuters Health) - Once-weekly treatment with pegylated interferon alpha-2a is both more effective and safer than standard interferon alpha-2a three times a week for interferon-naive dialysis patients with chronic hepatitis C virus (HCV) infection, according to a report by Taiwanese researchers published in the April issue of Gut.

The researchers note that the standard of care for HCV infection in dialysis patients is monotherapy with standard interferon, while mainstay therapy for patients with HCV infection and normal renal function is pegylated interferon and ribavirin. Ribavirin is considered contraindicated in dialysis patients because of the risk of severe hemolytic anemia.

For their study, Dr. Jia-Horng Kao, of National Taiwan University Hospital, Taipei, recruited 50 patients 18-65 years of age (mean 48.8) receiving regular dialysis who also had detectable HCV RNA for more than 6 months.

These participants were randomized on a 1:1 basis to receive either 135 �g subcutaneous pegylated interferon alpha-2a once a week or 3 million units of subcutaneous standard interferon alpha-2a three times a week. Each regimen was given on an outpatient basis for 24 weeks, after which patients were followed up for an additional 24 weeks.

Patients who received pegylated interferon alpha-2a had a significantly higher end-of-treatment virological response (p = 0.02) than those who had received standard interferon alpha-2a.

Fever was more common among patients receiving standard interferon alpha-2a than in those receiving the pegylated version (44% vs. 12%, p = 0.03). The treatment-related withdrawal rate of patients receiving standard interferon alpha-2a (20%) was significantly higher than the 0% rate among patients receiving the pegylated version (p = 0.04).

"This is a relatively small study with preliminary but promising results," Dr. Kao told Reuters Health. "Therefore, further large-scale studies are awaited to confirm our findings."

Clinicians who care for HCV patients on dialysis, he added, might consider a lower dose of pegylated interferon monotherapy for 24 weeks for those with active hepatitis or advanced fibrosis. He cautioned, however, that "attention must be paid to the adverse effects from the use of interferon, and on-treatment virological response such as the rapid virological response (HCV RNA undetectable at 4 weeks of therapy) should be monitored to predict the sustained virological response."

Gut 2008;57:525-530 .