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

December 3, 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: Factors ID'd to predict fatty liver in obese teens

Related Stories

Factors ID'd to predict fatty liver in obese teens

April 24, 2018
(HealthDay)—Ethnicity/race, markers of insulin resistance, and genetic factors might help identify obese youth at risk for developing fatty liver, according to a study published online April 17 in Hepatology.

Vitamin A derivative selectively kills liver cancer stem cells

April 23, 2018
Acyclic retinoid, an artificial compound derived from vitamin A, has been found to prevent the recurrence of hepatocellular carcinoma (HCC), the most common form of liver cancer. Now, in research published in Proceedings ...

Updates on new therapies in development for rare liver diseases

April 14, 2018
Promising results for three drugs for the treatment of three rare liver diseases were presented today at The International Liver Congress 2018 in Paris, France. Sebelipase alfa, approved for treatment of lysosomal acid lipase ...

HCV-related liver transplantation and post-transplant survival rates in Europe have improved rapidly

April 13, 2018
HCV-related liver transplantation rates in Europe have declined dramatically since the availability of direct-acting antiviral (DAA) drugs and survival rates after transplantation have reached an all-time high. A study presented ...

Alcoholic liver disease replaces hepatitis C infection as the leading cause of liver transplantation

April 11, 2018
Two independent studies have today reported that alcoholic liver disease has now replaced hepatitis C virus (HCV) infection as the leading cause of liver transplantation in the USA in patients without HCC. Non-alcoholic steatohepatitis ...

Hepatitis E virus infections can be life threatening and transmitted through blood products

April 12, 2018
Hepatitis E virus (HEV) infection is once again in the spotlight, with two studies presented today at The International Liver Congress 2018 in Paris, France challenging the ideas that HEV infections are benign and self-limiting, ...

Recommended for you

Antibody 'cocktail' can prevent Zika infection but is not effective for treatment of fetuses

April 26, 2018
A "cocktail" of monoclonal antibodies that can prevent Zika virus (ZIKV) infection in primates was not effective for treatment of fetuses, according to a new collaborative study led by a University of Miami Miller School ...

E. coli—are we measuring the wrong thing?

April 25, 2018
A sepsis awareness and management programme has demonstrated overall success in terms of improved sepsis detection, but has led to an increase in the number of E. coli blood stream infection cases presented, calling into ...

Malaria study reveals gene variants linked to risk of disease

April 25, 2018
Many people of African heritage are protected against malaria by inheriting a particular version of a gene, a large-scale study has shown.

Commonly prescribed heartburn drug linked to pneumonia in older adults

April 24, 2018
Researchers at the University of Exeter have found a statistical link between pneumonia in older people and a group of medicines commonly used to neutralise stomach acid in people with heartburn or stomach ulcers. Although ...

Kids with rare rapid-aging disease get hope from study drug

April 24, 2018
Children with a rare, incurable disease that causes rapid aging and early death may live longer if treated with an experimental drug first developed for cancer patients, a study suggests.

Early treatment for leg ulcers gets patients back on their feet

April 24, 2018
Treating leg ulcers within two weeks by closing faulty veins improves healing by 12 per cent compared to standard treatment, according to new findings.

0 comments

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.