New study presented at DDW re. fibrosis reversal after SVR

[Marc1955]

An optimistic study was just reported out of the DDW meeting in Chicago regarding a question often discussed on this board – how much reversal in liver damage can one expect if one achieves SVR through treatment?

"The use of interferon or peginterferon for the treatment of patients with hepatitis C can have a dramatic improvement on the histology of the disease, including the disappearance of cirrhosis," summarized Richard Sterling, MD, MSc, Professor of Medicine, Virginia Commonwealth University, and a study co-investigator. "The results of our study show that in patients who respond to treatment, the use of interferon or peginterferon in addition to ribavirin is very effective."

"Researchers conducted a longitudinal cohort study to evaluate the use of IFNTx on liver histology in patients with chronic HCV. Seven hundred and fifty five patients underwent liver biopsy and received a single course of IFNTx or no treatment. Of these patients, 230 were followed for five years without additional treatment (41 patients declined treatment and 189 received IFNTx without obtaining sustained virologic response) before undergoing a repeat liver biopsy. An additional 102 patients who received IFNTx and obtained sustained virologic response (SVR) underwent liver biopsy after five years.

"There were no significant differences in worsening of inflammation or fibrosis scores between those who did not undergo treatment or did not have an SVR. Factors associated with fibrosis progression were change in total inflammation and increase in piecemeal necrosis (interface hepatitis) on second biopsy and presence of interface hepatitis on baseline biopsy. Conversely, the 102 patients who achieved SVR had a significant reduction in fibrosis score; 73 percent of patients who had portal fibrosis on their first biopsy showed no evidence of scarring on the second biopsy, while 20 percent showed no change with treatment. Of the patients with bridging fibrosis on first biopsy (52 percent of the cohort with SVR), 35 percent had no scarring on the second biopsy, 23 percent had portal scarring, 38 percent remained unchanged and 4 percent had cirrhosis, which investigators believe could be a sampling error. For patients with cirrhosis on first biopsy (19 percent of the cohort with SVR), 50 percent had improved on second biopsy — 10 percent had no scarring, 10 percent had portal scarring and 30 percent had improved to bridging fibrosis. African American participants and patients with genotype 1 experienced less sustained virologic responses, which has been shown through other research."

This seems like it provides a good baseline for understanding how much improvement one might expect if one achieves SVR.

[smaug48]

>>Folks who treat and don't achieve SVR have the same rate of progression of liver disease as if they hadn't treated at all.

Now that's a real bummer - makes one wonder why...

If you haven't seen this thread for an interesting finding on fibrosis reversal:

http://www.medhelp.org/posts/Hepatitis-C/Good-news-for-fibrosis-reversal/show/966789

smaug

[Willy50]

Thanks Marc, I agree.
       It would seem to me that the data that I'm interested in would/could be included in the study.  It would also be a useful tool in driving people to treat presumably if there was significant progression in the 5 year period the group who chose to not treat.

Sometimes it's good to see those summaries and read their conclusions since I don't always "conclude" as well as professionals.  

Willy

[Marc1955]

Willy - Here's the link to the press release:

http://www.eurekalert.org/pub_releases/2009-06/aga-abm052909.php

Sorry I didn't post it before.

I didn't get the same impression about the progression of non-responders that you did. I think all the abstract states is that there was no difference in the progression of non-responders and those who didn't undergo treatment. It doesn't say anything about the rate of progression. Just that it was the same for non-responders and those who didn't treat. Perhaps that is answered in the full study.

Apropos – it is common on this board for folks to console people who didn't clear by saying, "well, at least you gave your liver a rest." It's a nice thing to say, but the research doesn't bear it out. Folks who treat and don't achieve SVR have the same rate of progression of liver disease as if they hadn't treated at all.

[apache1]

Marc, thanks for posting this interesting study.

Confused with this also, comparison between without svr and with ifntx and without tx....

apache

[Willy50]

Thanks for posting this summary.   I wish I had the full study. (or link)

It is a tad off topic but it would also be of interest to me in seeing the rate of staging progression over the 5 year period, both for the non-SVR's and for the non treaters.
There seems to be a suggestion that in 5 years both groups had little change.  That is good news for many of us who wait......
----------------------------------------------

"There were no significant differences in worsening of inflammation or fibrosis scores between those who did not undergo treatment or did not have an SVR.

Of these patients, 230 were followed for five years without additional treatment (41 patients declined treatment and 189 received IFNTx without obtaining sustained virologic response) before undergoing a repeat liver biopsy."
---------------------------------------------  (I hope that I interpreted this correctly-Willy)


By the way, there are some decent articles available....links from natap from the DDW.  Some of them are discussion of the EASL presentations.

http://www.natap.org/hcv.htm

best, and thanks again Marc......
Willy

[Rockerforlife]

This report sure makes the occult virus studies look trival.

[justme53]

Thanks for posting this, Marc. I think for many of us late stagers, this holds the promise of not only the possibility of clearing, but of healing our livers. I can't believe I used to scoff at 30%...even 50% odds. Compared to nothing, I'm glad for every possible percentage point I can get.