Treatment for advanced hepatitis C doesn't work, researchers find

Dec 03, 2008

An NIH funded multi-center clinical trial found no benefit from "maintenance therapy," low-dose peginterferon used for hepatitis C patients who have not responded to an initial round of treatment. In addition, the study showed a surprising health decline in patients with liver disease over the course of four years.

A Saint Louis University researcher was lead author and chairman of the study, which will be published in the Dec. 4 issue of the New England Journal of Medicine. The study ruled out low-dose peginterferon maintenance therapy as a treatment for patients with advanced chronic hepatitis.

"This course of treatment had been adopted by a number of doctors in the U.S. and in other countries, though it had yet to be proven to work. That practice should be stopped based on the results of this trial. There is no rationale for using maintenance therapy," said Adrian Di Bisceglie, M.D., professor of internal medicine, chief of hepatology and co-director of the Liver Center at Saint Louis University. "The treatment is clearly ineffective."

About 4 million people in the U.S. have been infected with hepatitis C; an estimated 10,000 to 12,000 people die from complications each year in this country. Hepatitis C is caused by a virus, transmitted by contact with blood, and may initially be asymptomatic. For patients who develop a chronic hepatitis C infection, inflammation of the liver may develop, leading to fibrosis and cirrhosis (scarring of the liver), as well as other complications including liver cancer and death.

For patients with chronic hepatitis C, the prognosis varies. About half fully recover after an initial course of peginterferon and ribavirin anti-viral therapy that may last from six months to a year.

The remaining patients, known as non-responders, may improve but the virus is not eliminated. Researchers studied these patients, looking at those with advanced liver disease as identified by liver biopsies that showed advanced scarring. These patients were at greatest risk for worsening.

The study looked at 1050 patients at 10 different clinical sites.

Researchers gave patients peginterferon for three and a half years, but in lower doses to try to suppress but not eliminate the virus, with the hope of slowing the dire consequences of liver disease. Half of the patients were treated with a low dose of peginterferon and half were put into a control group for a total of four years.

The results were clear; maintenance therapy did not stop liver disease from progressing.

In addition, researchers were startled by the rate of progression of liver disease. After four years, 30 percent of the patients in both the treatment and control groups had developed liver failure, liver cancer, or had died. Among those with milder cirrhosis, 10 to 12 percent developed severe liver disease, also unexpected.

"Hepatitis patients in these circumstances got very ill over the course of four years, surprisingly so," said Di Bisceglie. "The lesson we learned is that once chronic hepatitis C gets to the stage of advanced fibrosis, patients can decline rapidly."

As doctors look to the future, their hope rests on new drugs that are currently in clinical trials.

Source: Saint Louis University

Explore further: Recorded Ebola deaths top 7,000

add to favorites email to friend print save as pdf

Related Stories

Most detailed picture ever of key part of hepatitis C

Nov 28, 2013

Scientists at The Scripps Research Institute (TSRI) have determined the most detailed picture yet of a crucial part of the hepatitis C virus, which the virus uses to infect liver cells. The new data reveal ...

Recommended for you

Recorded Ebola deaths top 7,000

19 hours ago

The worst Ebola outbreak on record has now killed more than 7,000 people, with many of the latest deaths reported in Sierra Leone, the World Health Organization said as United Nations Secretary-General Ban ...

Liberia holds Senate vote amid Ebola fears (Update)

Dec 20, 2014

Health workers manned polling stations across Liberia on Saturday as voters cast their ballots in a twice-delayed Senate election that has been criticized for its potential to spread the deadly Ebola disease.

Evidence-based recs issued for systemic care in psoriasis

Dec 19, 2014

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

Bacteria in caramel apples kills at least four in US

Dec 19, 2014

A listeria outbreak believed to originate from commercially packaged caramel apples has killed at least four people in the United States and sickened 28 people since November, officials said Friday.

Steroid-based treatment may answer needs of pediatric EoE patients

Dec 19, 2014

A new formulation of oral budesonide suspension, a steroid-based treatment, is safe and effective in treating pediatric patients with eosinophilic esophagitis (EoE), according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.