DDW: Interferon Has Long-Term Histo Benefits in HCV

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By Todd Neale, Staff Writer, MedPage Today
Published: June 03, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner CHICAGO, June 3 -- A single course of interferon-based therapy, with or without ribavirin, produces long-term improvements in liver histology in patients with hepatitis C (HCV) who completely clear the virus, researchers found. Action Points

Explain to interested patients that this study showed long-term improvements in inflammation and fibrosis only in HCV patients who had a sustained virologic response to standard therapy.

Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.



Patients who had a sustained virologic response had significant reductions in inflammation and fibrosis of the liver five or six years after receiving treatment, Mitchell Shiffman, M.D., of Virginia Commonwealth University, reported at Digestive Disease Week here.

Even half of the patients who had cirrhosis improved if they responded to therapy.

"We used to think that once you had cirrhosis, it was sort of a done deal, and no matter what happened, you couldn't get any improvement," said co-investigator Richard Sterling, M.D., also at Virginia Commonwealth. "But this study now confirms that some of those patients can actually resolve their liver scarring and inflammation."



Several studies have shown that patients with chronic HCV can develop increased liver fibrosis over time. But the long-term impact of interferon-based therapy (in patients with and without a sustained virologic response) remained unknown, Dr. Sterling said.

Uncontrolled studies have shown that patients with a sustained virologic response have improvements in liver histology following a single course of interferon-based therapy, he said.

There has even been some suggestion that patients who do not have a response to therapy have reduced scarring in the short term, he said.

To explore the issue, Drs. Shiffman and Sterling and their colleagues began a prospective, longitudinal cohort study in 1991.

They included all patients who had a liver biopsy and either declined treatment (46 patients) or received a single course of interferon-based therapy, with or without ribavirin (287 patients).

All patients received a follow-up biopsy five or six years later. Most studies looking at the effect of therapy on liver histology have only followed up at 24 or 48 weeks, Dr. Sterling said.

The patients who decided not to undergo treatment generally had mild disease, as indicated by lower inflammation and fibrosis scores and lower serum alanine aminotransferase.

Of those who underwent treatment, 185 did not have a sustained virologic response and 102 did.

Patients who declined treatment and those who underwent treatment but failed to respond had similar increases in both inflammation and fibrosis of the liver ( P

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