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[Long-term follow-up of chronic hepatitis C after treatment with recombinant interferon alpha-2a]
1Medizinische Klinik und Poliklinik, Universitätsklinikum Rudolf Virchow, Freie Universität Berlin.
Insights
Recombinant interferon alfa (IFN alpha-2a) treatment for chronic hepatitis C showed sustained remission in patients with normalized aminotransferases and negative HCV-RNA after therapy. Early normalization predicts long-term outcomes.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis C (HCV) infection poses a significant global health burden.
- Recombinant interferon alfa (IFN alpha-2a) has been explored as a treatment option for HCV.
- Understanding treatment efficacy and long-term outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the efficacy and long-term outcomes of recombinant interferon alfa (IFN alpha-2a) in chronic hepatitis C patients.
- To assess the prognostic relevance of aminotransferase normalization and HCV-RNA negativity.
- To determine the impact of dose escalation on treatment response.
Main Methods:
- A multicenter randomized study involving 40 chronic hepatitis C patients treated with IFN alpha-2a.
- Standard dosage and dose escalation strategies were employed based on serological response.
- Patients were followed for 3 years, with assessments including aminotransferase levels, HCV-RNA polymerase chain reaction (PCR), and liver histology.
Main Results:
- Aminotransferase normalization rates were 42% at 2 months, decreasing to 23% at 3 years.
- HCV-RNA PCR negativity was achieved in 73% at 2 months, sustained by 35% at 3 years.
- Dose escalation in 8 patients did not improve the response rate; histological improvement was observed in 61%.
Conclusions:
- Early normalization of aminotransferases within two months is a strong predictor of sustained remission.
- Persisting normal aminotransferases and negative HCV-RNA for one year post-therapy indicate maintained remission.
- IFN alpha-2a treatment efficacy is suggested by histological improvement, particularly in patients achieving serological remission.
Abstract:
As part of a multicenter randomized study 40 patients with chronic hepatitis C (HCV)-infection, 28 kryptogenic and 12 posttransfusional, were treated with recombinant interferon alfa (IFN alpha-2a) for 1 year in a dosage of 3 x 3 Mio. units per week versus dosis escalation after 8 and 16 weeks in serological non-responders. 36 of the 40 patients were followed over 3 years. The rate of patients with normalization of aminotransferases was 42% after two months of therapy, 28% at the end of treatment, 28% after 1 year and 23% after 3 years of follow-up. The polymerase chain reaction (PCR) for detection of HCV-RNA became negative after two months of treatment in 73%, at the end of therapy in 63%, after 1 year follow-up in 63% and after 3 years in 35%. All patients with persisting remission maintained HCV-RNA negative. Dosis escalation was realized in 8 patients without increase of responder rate. Antibodies against IFN alpha-2a developed in 4 (10%) patients without remarkable influence on the IFN-effect. Histological improvement at the end of treatment was observed in 61% including all patients with serological remission. The data support the prognostic relevance of the course of aminotransferases. If aminotransferases are not normalized during the first two months the treatment can be terminated. Persisting normalization of aminotransferases during 1 year after therapy and negative HCV-PCR result indicate maintaining remission.