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| |  AASLD: Use of Prophylactic Antiviral Strategy Has Limitations in Patients with Hepatitis C Undergoing Liver Transplantation By Charles Bankhead Special to DG News BOSTON, MA -- November 3, 2002 -- Full-dose prophylactic antiviral therapy proved feasible and successful in only a quarter of hepatitis C-infected patients undergoing liver transplantation, suggesting the strategy might have limited impact against recurrent HCV infection in transplant recipients. Of 110 patients screened for antiviral therapy, 35 percent were actually treated and 26 percent completed 48 weeks of treatment with interferon alpha-2b with or without ribavirin, reported Dr. Norah Terrault, an internist at University of California, San Francisco, California, United States, speaking here November 1 at the American Association for the Study of Liver Disease (AASLD). Use of growth factor support (G-CSF) and erythropoietin did reduce early discontinuation due to cytopenia, she added. Overall discontinuation rates were similar between patients who received interferon alone or interferon plus ribavirin. "Because anaemia is more common in the post-transplant period, there had been speculation that use of ribavirin with interferon would be more problematic," Dr. Terrault explained. "However, our results indicate that ribavirin is not a major factor in the tolerability of prophylactic antiviral therapy." Recurrent hepatitis C is a common cause of graft dysfunction after liver transplantation. Initiation of prophylactic antiviral therapy within weeks of transplantation has been seen as a potential means to reduce the risk of recurrent infection, said Dr. Terrault. However, until now, the safety and tolerability of prophylactic antiviral therapy in liver transplant recipients has not been carefully evaluated. Of the 110 patients screened for eligibility, the primary reasons for study exclusion were prolonged stay in intensive care unit (39 percent) and prolonged anaemia (27 percent). Dr. Terrault said 47 patients were eligible for therapy, but eight discontinued before receiving the initial interferon dose. Of the 39 patients who began treatment, 19 were randomised to interferon alpha-2b alone and 20 received interferon plus ribavirin. The interferon dose started at 1.5M U per day and increased to 3M U per day over eight weeks, followed by 3M U/TIW for 40 weeks. The ribavirin dose started at 600 mg per day for two weeks and then increased to 1.0 to 2.0 g per day. Twelve patients on interferon alone and nine receiving combination antiviral therapy required dose reductions, and seven patients in each group completed 48 weeks of treatment. Use of growth factors increased the proportion of eligible patients from 39 percent to 49 percent, and no patient receiving growth factors discontinued treatment prematurely because of cytopaenia. The study was supported by Fugisawa Healthcare Inc.
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