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Gender more than IFN dosage determines rate of response in HCV + chronic active hepatitis
Viral hepatitis: clinical aspects i C061089 1
[ C0~091 ]
GENDER MORE THAN IFN DOSAGE DETERMINES RATE OF RESPONSE IN HCV+CHRONIC ACTIVE HEPATITIS P. Esposito, C. Cremonini, A. Grottola, P. Buttafoco, A. Scarcelli, H. Bertani, M.G. Del Buono, E Giannini, E Manenti, E. Villa Dept. of Internal Medicine, University of Modena, Modena, Italy. Aim of our study was to verify whether pre-stratifieation of patients according to a severity score and allocation to increasing IFN doses, was able to improve the outcome of antiHCV+ CAll. Score (built on: HCV genotype, semiquantitative viremia, Knodell's score, GGT levels and duration of disease) identified 3 groups: very severe (G1), moderately severe (G2) and mild (G3) hepatitis. Within each group, patients were randomized to a fixed dose IFN regimen (3 MU thrice weekly for 6 month)(St) or to a personalized (P) dose (Gl:5 or G2:3 or G3:1 MU/sqm, thrice weekly for 6 month). Results: 144 patients were enrolled. A higher male prevalence was present in G1 (33 vs. 6*/0). There was no statistically significant difference within each group, neither in primary nor in long-term response, between St and P dosage (St vs. P: STR: 26 vs. 25%; LTR: 13% vs.16%)(p=.587). Females had a significantly better response than males (F vs. M: 19,5% vs.8%Xp=.003); young males responded better than older ones (<33 vs.>33 yrs: 6% vs.l%)(p=.002). Conclusions: 1. In mild hepatitis, very low dosages have the same effect than standard dose; 2. In severe hepatitis, even high IFN doses are not associated with better response; 3. The best results cluster in females, independently from age, and in young males; older males represent a category resistant to IFN therapy (Grant 40*/0 Virus).
THE RELATIONS~S,ETW~EN SERUM ALT LEVELS, V,ROLOGICAL CHARACTERISTICS, AND LIVER HISTOLOGY IN PATIENTS WITH CHRONIC HEPATITIS C: CLINICAL IMPLICATIONS OF INIMUNOPATHOGENESlS OF HCV S.K. Yoon, B.H. Byun, E.S. Chung ], Y.M. Park, T.W. Park, J.M. Yang, B.M. Ahn, Y.S. Lee, K.W. Chung, H.S. Sun, B.K. Kim], B.S. Kim Division of Hepato-Gastroenterology, Department of Internal Medicine, 1Department of Pathology, College of Medicine, Catholic University of Korea, Seoul, Korea. BACKGROUNDS AND AIM. It is unclear whether serum ALT levels or virological characteristics of HCV including HCV genotype and HCV RNA titers can reflect the histological activity in chronic hepatitis C. The aim of this study was to investigate whether serum ALT levels, HCV genotype or HCV RNA titers are associated with the levels of histological damage in chronic hepatitis C. METHODS. All fifty-six patients underwent liver biopsy and the histological activity index(HA/) were evaluated by Knodell's scoring system. HCV genotype by R T - PCR and HCV RNA quantitatJon by competitive R T - PCR were performed. RESULTS. Thirty- four patients were infected with HCV genotype lb, 20 patients with genotype 2a and 2 patients with undetermined type. Serum ALT levels were not positively correlated with total HAl score or HCV RNA levels, but showed linear correlation with piecemeal necrosis (r=0.32 p
I C06/090 I
I C06/092 I
INTERFERON ALFA AND/OR LAMIVUDINE THERAPY IN CHRONIC DELTA HEPATITIS U.S. Akarca, G. Ers6z, E Gt~nsar,Z. Karasu, H. (~avu$o~lu,Y. Batur Dep. Gastroenterology, Ege University Medical School, Turkey. Secotffgeneration n u c k x ~ analogs, which me used in the Ireament of chronic hepefitisB infection,like lamivudine (Lam), may also be expected to take place in the treament of CHD. Tbe aim of this study is to c~veae ~e effectsof ¢zlFNand/or l.zen alone or in ~ , on ~ and histologictespome in CHD. Melhads: ElevenlxaientsreceivedLain (150rag/d), 10patients r~x~ivedcdFN 10MU/rlW and9 patientsreceived I . a r ~ cdFN c~xd:hna6ontherapy (CT) in the smae doses, for 12 month~ Results: Histologic At~ivity~ and serum ALT levelsbefore and after tbe mmmaemthas beem,daownin flaetable-1. Before Treatment After Trearnent Age HA1 ALT* HAl i ALT* I_am 47±12 13-~-4 99 9+_3 79 l:e,0.05 IFN 37±6 12±5 129 4+_2 45 , p
COMBINATION THERAPY WITH INTERFERON ALPHA-2B AND RIBAVIRIN IN NAIVE PATIENTS WITH CHRONIC HEPATITIS C J. Juszczyk1, B. Bolewskal, J. Cianciara2, J. Jablonska2, P Zaborowski3, D. Niedzialek3, A. Gladysz4, P. Piszko4 tDept of Infectious Dis., University of Medical Sciences, Poznan, Poland. 2Institute of Infectious Dis., Medical Academy, Warsaw, Poland. 3Dept. of Gastroenterol. Central Hosp. Military Med. School, Warsaw, Poland. 4Dept. of Infectious Dis., Wroclaw, Poland.
HAt'Hino~icactivi~,~ex(r~an~tm~ndeviatim~ *median ALT levels decreased to nonrml in five ~ (%50) with ffJFN tbempy, in 3 l~tients (%27) with I_zantherapy, in 2 izetiens (%22) with CT. IFN and CT g~axpsshowed a statisticallysignificantdecrease in HAl. ~ ffJFN and ¢fiFN+l_zmcombination therapy indtxzeda significantdecrease in ALT levelsand HAL Only l_zm therapy was not effectiveon ALT n~maliz~on. Lain and ¢xlFN combimliontherapydid not have additionaleffectcomparing wilh cdFN alone.
The aim of the study was to assess the efficacy and the safety of combination therapy in naive patients with chronic hepatitis C based on biochemical and virological results. Patients and methods: 37 (M-22, F-15, mean age-40,9) adult patients with abnormal ALT levels, anti-HCV- positive, HCV-RNA in serum positive were included. All treated with interferon alpha-2b, subcutaneously, tiw. 3 MU and ribavirin (1000-1200 mg/day) for 6 months and followed for additional 6 months after treatment. Results: ETR and SR were defined as undetectable serum HCVRNA (by PCR) and normalization of ALl" at the end of treatment (week 24) and at the end of follow up ( week 48). The table presents the results: Time of Numberof patients(%) assessing ALT HCV-RNA(-) ALT normalisationand normalisaUon HCV-RNA(-) 24 week 32 (86,5%) 14(41%) 13(35%)ETR 48 week 17 (46%) 10 (29%) 6 (18%) SR Conclusion: End of treatment response was observed in 35% and sustained response was assessed in 18% of patient treated 6 months with combination therapy.
199
[ C0~091 ]
GENDER MORE THAN IFN DOSAGE DETERMINES RATE OF RESPONSE IN HCV+CHRONIC ACTIVE HEPATITIS P. Esposito, C. Cremonini, A. Grottola, P. Buttafoco, A. Scarcelli, H. Bertani, M.G. Del Buono, E Giannini, E Manenti, E. Villa Dept. of Internal Medicine, University of Modena, Modena, Italy. Aim of our study was to verify whether pre-stratifieation of patients according to a severity score and allocation to increasing IFN doses, was able to improve the outcome of antiHCV+ CAll. Score (built on: HCV genotype, semiquantitative viremia, Knodell's score, GGT levels and duration of disease) identified 3 groups: very severe (G1), moderately severe (G2) and mild (G3) hepatitis. Within each group, patients were randomized to a fixed dose IFN regimen (3 MU thrice weekly for 6 month)(St) or to a personalized (P) dose (Gl:5 or G2:3 or G3:1 MU/sqm, thrice weekly for 6 month). Results: 144 patients were enrolled. A higher male prevalence was present in G1 (33 vs. 6*/0). There was no statistically significant difference within each group, neither in primary nor in long-term response, between St and P dosage (St vs. P: STR: 26 vs. 25%; LTR: 13% vs.16%)(p=.587). Females had a significantly better response than males (F vs. M: 19,5% vs.8%Xp=.003); young males responded better than older ones (<33 vs.>33 yrs: 6% vs.l%)(p=.002). Conclusions: 1. In mild hepatitis, very low dosages have the same effect than standard dose; 2. In severe hepatitis, even high IFN doses are not associated with better response; 3. The best results cluster in females, independently from age, and in young males; older males represent a category resistant to IFN therapy (Grant 40*/0 Virus).
THE RELATIONS~S,ETW~EN SERUM ALT LEVELS, V,ROLOGICAL CHARACTERISTICS, AND LIVER HISTOLOGY IN PATIENTS WITH CHRONIC HEPATITIS C: CLINICAL IMPLICATIONS OF INIMUNOPATHOGENESlS OF HCV S.K. Yoon, B.H. Byun, E.S. Chung ], Y.M. Park, T.W. Park, J.M. Yang, B.M. Ahn, Y.S. Lee, K.W. Chung, H.S. Sun, B.K. Kim], B.S. Kim Division of Hepato-Gastroenterology, Department of Internal Medicine, 1Department of Pathology, College of Medicine, Catholic University of Korea, Seoul, Korea. BACKGROUNDS AND AIM. It is unclear whether serum ALT levels or virological characteristics of HCV including HCV genotype and HCV RNA titers can reflect the histological activity in chronic hepatitis C. The aim of this study was to investigate whether serum ALT levels, HCV genotype or HCV RNA titers are associated with the levels of histological damage in chronic hepatitis C. METHODS. All fifty-six patients underwent liver biopsy and the histological activity index(HA/) were evaluated by Knodell's scoring system. HCV genotype by R T - PCR and HCV RNA quantitatJon by competitive R T - PCR were performed. RESULTS. Thirty- four patients were infected with HCV genotype lb, 20 patients with genotype 2a and 2 patients with undetermined type. Serum ALT levels were not positively correlated with total HAl score or HCV RNA levels, but showed linear correlation with piecemeal necrosis (r=0.32 p
I C06/090 I
I C06/092 I
INTERFERON ALFA AND/OR LAMIVUDINE THERAPY IN CHRONIC DELTA HEPATITIS U.S. Akarca, G. Ers6z, E Gt~nsar,Z. Karasu, H. (~avu$o~lu,Y. Batur Dep. Gastroenterology, Ege University Medical School, Turkey. Secotffgeneration n u c k x ~ analogs, which me used in the Ireament of chronic hepefitisB infection,like lamivudine (Lam), may also be expected to take place in the treament of CHD. Tbe aim of this study is to c~veae ~e effectsof ¢zlFNand/or l.zen alone or in ~ , on ~ and histologictespome in CHD. Melhads: ElevenlxaientsreceivedLain (150rag/d), 10patients r~x~ivedcdFN 10MU/rlW and9 patientsreceived I . a r ~ cdFN c~xd:hna6ontherapy (CT) in the smae doses, for 12 month~ Results: Histologic At~ivity~ and serum ALT levelsbefore and after tbe mmmaemthas beem,daownin flaetable-1. Before Treatment After Trearnent Age HA1 ALT* HAl i ALT* I_am 47±12 13-~-4 99 9+_3 79 l:e,0.05 IFN 37±6 12±5 129 4+_2 45 , p
COMBINATION THERAPY WITH INTERFERON ALPHA-2B AND RIBAVIRIN IN NAIVE PATIENTS WITH CHRONIC HEPATITIS C J. Juszczyk1, B. Bolewskal, J. Cianciara2, J. Jablonska2, P Zaborowski3, D. Niedzialek3, A. Gladysz4, P. Piszko4 tDept of Infectious Dis., University of Medical Sciences, Poznan, Poland. 2Institute of Infectious Dis., Medical Academy, Warsaw, Poland. 3Dept. of Gastroenterol. Central Hosp. Military Med. School, Warsaw, Poland. 4Dept. of Infectious Dis., Wroclaw, Poland.
HAt'Hino~icactivi~,~ex(r~an~tm~ndeviatim~ *median ALT levels decreased to nonrml in five ~ (%50) with ffJFN tbempy, in 3 l~tients (%27) with I_zantherapy, in 2 izetiens (%22) with CT. IFN and CT g~axpsshowed a statisticallysignificantdecrease in HAl. ~ ffJFN and ¢fiFN+l_zmcombination therapy indtxzeda significantdecrease in ALT levelsand HAL Only l_zm therapy was not effectiveon ALT n~maliz~on. Lain and ¢xlFN combimliontherapydid not have additionaleffectcomparing wilh cdFN alone.
The aim of the study was to assess the efficacy and the safety of combination therapy in naive patients with chronic hepatitis C based on biochemical and virological results. Patients and methods: 37 (M-22, F-15, mean age-40,9) adult patients with abnormal ALT levels, anti-HCV- positive, HCV-RNA in serum positive were included. All treated with interferon alpha-2b, subcutaneously, tiw. 3 MU and ribavirin (1000-1200 mg/day) for 6 months and followed for additional 6 months after treatment. Results: ETR and SR were defined as undetectable serum HCVRNA (by PCR) and normalization of ALl" at the end of treatment (week 24) and at the end of follow up ( week 48). The table presents the results: Time of Numberof patients(%) assessing ALT HCV-RNA(-) ALT normalisationand normalisaUon HCV-RNA(-) 24 week 32 (86,5%) 14(41%) 13(35%)ETR 48 week 17 (46%) 10 (29%) 6 (18%) SR Conclusion: End of treatment response was observed in 35% and sustained response was assessed in 18% of patient treated 6 months with combination therapy.
199