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TITLE: Chronic hepatitis C: interferon retreatment
of relapsers. A meta-analysis of individual patient data.
Relapse after interferon (IFN) therapy for chronic hepatitis C
virus (HCV) infection occurs in 50% of patients after the initial
response. The benefit of retreatment with IFN alone has not been
assessed in large controlled studies. To assess the effectiveness
and the tolerability of IFN retreatment and to identify the optimal
second course regimen, we performed a meta-analysis of individual
patient's data on a set of 549 patients (mean age 43.8 years; 12.2
SD, men: 65%) who had an end-of-treatment biochemical response to a
first IFN course and then relapsed. Retreatment was started within
24 months after the end of the first course. Biochemical
end-of-treatment responses (ETR) and sustained responses (SR) were
observed in 405 of 549 (73.8%; 95% confidence interval [CI]
70.1-77.5) and in 124 of 549 (22.6%; CI 19.1-26.1) patients,
respectively. One hundred seventy-five of 404 patients (43.3%; CI
38.6-48.2) developed an end-of-treatment, biochemical, and
virological response when retreated. A biochemical and virological
SR to retreatment occurred in 73 of 494 (14.8%; CI 11.7-18)
patients. Thirty-two patients (5. 8%; CI 3.5-7.8) stopped
retreatment for adverse effects. Biochemical and virological SR was
predicted independently by logistic regression analysis using a
negative HCV RNA at the end of the first cycle of IFN (P =.01) and
by retreatment with a high IFN dose (P =. 03). Age, cirrhosis,
genotype, and gamma-glutamyl transferase levels before retreatment
were not significant by multivariate analysis. The excellent
tolerability of IFN monotherapy retreatment makes it an option for
patients who transiently cleared HCV-RNA during their first IFN
course. Patients should be retreated with a high IFN dose
regardless of the strength of the dose received during the previous
course of treatment.
AUTHOR: Camma C, Giunta M, Chemello L, Alberti A, Toyoda H,
Trepo C, Marcellin P, Zahm F, Schalm S, Craxi A, Istituto
Metodologie Diagnostiche Avanzate, Consiglio Nazionale delle
Ricerche, Palermo, Italy.
SOURCE: Hepatology 1999 Sep;30(3):801-7
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