Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C.
By T. Poynard, J. Mchutchison, M. Manns, C. Trépo, K. Lindsay, Z. Goodman, M. Ling, J. Albrecht. Gastroenterology, 2002
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BACKGROUND & AIMS Liver fibrosis is an important prognostic factor in patients with hepatitis C. The effect of pegylated (PEG) interferon alone or its combination with ribavirin on fibrosis has not been established. METHODS We pooled individual data from 3010 naive patients with pretreatment and posttreatment biopsies from 4 randomized trials. Ten different regimens combining standard interferon, PEG interferon, and ribavirin were compared. The impact of each regimen was estimated by the percentage of patients with at least 1 grade improvement in the necrosis and inflammation (METAVIR score), the percentage of patients with at least 1 stage worsening in fibrosis METAVIR score, and by the fibrosis progression rate per year. RESULTS Necrosis and inflammation improvement ranged from 39% (interferon 24 weeks) to 73% (optimized PEG 1.5 and ribavirin; P < 0.001). Fibrosis worsening ranges from 23% (interferon 24 weeks) to 8% (optimized PEG 1.5 and ribavirin; P < 0.001). All regimens significantly reduced the fibrosis progression rates in comparison to rates before treatment. The reversal of cirrhosis was observed in 75 patients (49%) of 153 patients with baseline cirrhosis. Six factors were independently associated with the absence of significant fibrosis after treatment: baseline fibrosis stage (odds ratio [OR] = 0.12; P < 0.0001), sustained viral response (OR = 0.36; P < 0.0001), age < 40 years (OR = 0.51; P < 0.001), body mass index < 27 kg/m(2) (OR = 0.65; P < 0.001), no or minimal baseline activity (OR = 0.70; P = 0.02), and viral load < 3.5 millions copies per milliliter (OR = 0.79; P = 0.03). CONCLUSIONS PEG-interferon and ribavirin combination significantly reduces the rate of fibrosis progression in patients with hepatitis C.
Subfields: Epidemiology, Hepatology
View Paper: https://www.semanticscholar.org/paper/e6a063bc9eab3c10e7eb22606aad37658f584ef9
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Citations in the corpus
- WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. (2015, neutral): “In a study that evaluated liver fibrosis in a cohort of 422 patients without a gold standard, Poynard et al. (2013) report that the applicability of SWSI is lower than that of TE whereas the performance of the two methods is similar.”
- Sustained Virologic Response and Clinical Outcomes in Patients with Chronic Hepatitis C and Advanced Fibrosis (2007, background): “Among 3010 patients for whom pre- and posttreatment biopsy results were available in Poynard and associates’ study (3), reversal of fibrosis occurred in 12% of those treated for 24 weeks with standard interferon and up to 24% of those treated with an optimal schedule of pegylated interferon and riba”
- Liver fibrosis -- from bench to bedside. (2003, background): “Moreover, since fibrosis in HCV typically progresses over three decades, one might anticipate that an equally slow but steady regression might follow its clearance .”
- Hepatitis C Guidance 2019 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection (2019, background): “ Noninvasive tests to assess liver Disease Severity Liver-directed physical exam (normal in most patients) Routine blood tests (e.g., ALT, AST, albumin, bilirubin, INR, and CBC with platelet count) Serum fibrosis marker panels Transient elastography Liver imaging (e.g., ultrasound or computed tomogr”