Epidemiology

Peginterferon, beta-blockers do not cut risk of varices in hepatitis C patients

Last Updated: 2010-03-26 19:30:08 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Prolonged treatment with low-dose peginterferon-alpha2a and beta-blockers does not cut the risk of variceal formation or progression in patients with hepatitis C, new research shows.

But race, ethnicity, and disease severity do affect patients' risk for varices, the researchers report in a March 8th online paper in Gastroenterology.

To identify predictors of variceal formation, Dr. Robert J. Fontana of the University of Michigan Medical School, Ann Arbor, and colleagues analyzed data on 598 patients with chronic hepatitis C virus infection who had no varices when they enrolled in a trial of low-dose peginterferon-alpha2a therapy.

Over a median follow-up of 4 years, 157 patients (26.2%) developed varices. Most (76.4%) were small, and only 1% of patients had variceal hemorrhage.

Randomization to the peginterferon maintenance arm did not influence the outcome, nor did the frequency of beta-blocker use.

However, the risk of varices ranged from 13% in African Americans to 22% in Caucasians and 44% in Hispanics. In addition to race, other significant risk factors were lower baseline levels of albumin and higher levels of hyaluronic acid.

Among a second group of 210 patients who had varices at baseline, 74 (35.2%) had variceal progression or bleeding during follow-up. Those with higher baseline ratios of serum aspartate to alanine aminotransferase and lower platelet counts were at greatest risk of variceal progression.

"Use of the risk factors that we've identified may help improve patient and physician adherence with recommendations for endoscopic screening," Dr Fontana told Reuters Health by email. "They also may be useful in targeting the highest risk patients for the most frequent follow-up."

Gastroenterology 2010.