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Prolonged Therapy of Advanced Chronic Hepatitis C with Low-Dose Peginterferon

http://content.nejm.org/cgi/content/short/359/23/2429?query=TOC

ABSTRACT

Background

In patients with chronic hepatitis C who do not have a response to antiviral treatment, the disease may progress to cirrhosis, liver failure, hepatocellular carcinoma, and death.
Whether long-term antiviral therapy can prevent progressive liver disease in such patients remains uncertain.

Methods
We conducted a randomized, controlled trial of peginterferon alfa-2a at a dosage of 90 µg per week for 3.5 years, as compared with no treatment, in 1050 patients with chronic hepatitis C and advanced fibrosis who had not had a response to previous therapy with peginterferon and ribavirin. The patients, who were stratified according to stage of fibrosis (622 with noncirrhotic fibrosis and 428 with cirrhosis), were seen at 3-month intervals and underwent liver biopsy at 1.5 and 3.5 years after randomization.
The primary end point was progression of liver disease, as indicated by death, hepatocellular carcinoma, hepatic decompensation, or, for those with bridging fibrosis at baseline, an increase in the Ishak fibrosis score of 2 or more points.

Results

We randomly assigned the patients to receive peginterferon (517 patients) or no therapy (533 patients) for 3.5 years.
The level of serum aminotransferases, the level of serum hepatitis C virus RNA, and histologic necroinflammatory scores all decreased significantly (P<0.001) with treatment, but there was no significant difference between the groups in the rate of any primary outcome (34.1% in the treatment group and 33.8% in the control group; hazard ratio, 1.01; 95% confidence interval, 0.81 to 1.27; P=0.90). The percentage of patients with at least one serious adverse event was 38.6% in the treatment group and 31.8% in the control group (P=0.07).

Conclusions
Long-term therapy with peginterferon did not reduce the rate of disease progression in patients with chronic hepatitis C and advanced fibrosis, with or without cirrhosis, who had not had a response to initial treatment with peginterferon and ribavirin. (ClinicalTrials.gov number, NCT00006164 [ClinicalTrials.gov]

Source Information

From Saint Louis University School of Medicine, St. Louis (A.M.D.); the Virginia Commonwealth University Medical Center, Richmond (M.L.S.); the University of Colorado School of Medicine, Denver (G.T.E.); the Keck School of Medicine, University of Southern California, Los Angeles (K.L.L.); the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (J.E.E., E.C.W., M.G.G.); the University of Texas Southwestern Medical Center, Dallas (W.M.L.); the University of Michigan Medical Center, Ann Arbor (A.S.L.); the University of Connecticut Health Center, Farmington (H.L.B.); the University of California, Irvine, and the Veterans Affairs Long Beach Healthcare System, Long Beach, CA (T.R.M.); the University of Washington, Seattle (C.M.); the New England Research Institutes, Watertown, MA (K.K.S.); and Massachusetts General Hospital and Harvard Medical School, Boston (J.L.D.).

Address reprint requests to Dr. Di Bisceglie at the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, 3635 Vista Ave., St. Louis, MO 63110, or at [e-mail].

Adrian M. Di Bisceglie, M.D., Mitchell L. Shiffman, M.D., Gregory T. Everson, M.D., Karen L. Lindsay, M.D., James E. Everhart, M.D., M.P.H., Elizabeth C. Wright, Ph.D., M.P.H., William M. Lee, M.D., Anna S. Lok, M.D., Herbert L. Bonkovsky, M.D., Timothy R. Morgan, M.D., Marc G. Ghany, M.D., Chihiro Morishima, M.D., Kristin K. Snow, Sc.D., Jules L. Dienstag, M.D., for the HALT-C Trial Investigators