Randomized clinical trial: a pilot study investigating the safety and effectiveness of an escalating dose of peginterferon α-2a monotherapy for 48 weeks compared with standard clinical care in patients with hepatitis C cirrhosis.

Sudeep Tanwar*, Mark Wright, Graham R. Foster, Stephen D. Ryder, Peter R. Mills, Matthew E. Cramp, Julie Parkes, William M. Rosenberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: A substantial proportion of patients with chronic hepatitis C virus (HCV) cirrhosis fail to eradicate infection and develop liver-related complications. Despite evidence that interferon-α has an antifibrotic effect, clinical trials have demonstrated that low-dose maintenance interferon does not improve outcomes in patients with compensated HCV cirrhosis following a lead-in phase of interferon. In a pilot study, we have investigated the efficacy of an escalating dose of pegylated interferon α-2a (PEG-IFN2a) as compared with standard clinical care in patients with more advanced HCV Child's A or B cirrhosis without a lead-in phase. METHODS: In a prospective study, 40 patients were randomized to receive either standard clinical care (no further antiviral therapy) or 48 weeks of treatment with PEG-IFN2a starting at 90 mcg and escalating to 180 mcg weekly if tolerated. Patients were thereafter followed for a mean duration of 41 months. The primary outcome variables were liver-related death, all-cause mortality and sustained virological response. The secondary outcomes were 'liver-related events' and health-related quality of life. RESULTS: Both groups were well matched, with treatment well tolerated. The incidences of all-cause mortality (P=0.024) and nononcological liver morbidity (P=0.04) were significantly higher in the control arm after a mean of 47 months of follow-up. CONCLUSION: A 48-week escalating dose of PEG-IFN2a is associated with a significant reduction in all-cause mortality and nononcological liver-related morbidity in this trial. Further investigation of PEG-IFN2a is warranted for patients with advanced HCV-related cirrhosis for whom there is no other treatment and where transplantation is associated with rapid progression to cirrhosis.
Original languageEnglish
Pages (from-to)543-550
Number of pages0
JournalEur J Gastroenterol Hepatol
Volume24
Issue number5
DOIs
Publication statusPublished - May 2012

Keywords

  • Adult
  • Antiviral Agents
  • Biomarkers
  • Dose-Response Relationship
  • Drug
  • Female
  • Hepatitis C
  • Chronic
  • Humans
  • Interferon-alpha
  • Kaplan-Meier Estimate
  • Liver Cirrhosis
  • Male
  • Middle Aged
  • Pilot Projects
  • Polyethylene Glycols
  • Prospective Studies
  • Quality of Life
  • Recombinant Proteins
  • Treatment Outcome

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