Aa
article about maintenance for nonresponders
I knew the results of the trial for maintenance therapy were negative but this article spelled out just how negative they were. We sure won't be doing that. -Ev
WEDNESDAY, Dec. 3 (HealthDay News) -- Maintenance therapy using low-dose peginterferon doesn't help patients with advanced chronic hepatitis C who haven't responded to an initial round of treatment, new research suggests.
The study also showed a surprising health decline in patients with liver disease over the course of four years.
"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. The treatment is clearly ineffective," study author Dr. Adrian Di Bisceglie, chief of hepatology and co-director of the Liver Center at Saint Louis University, said in a university news release.
About half of patients with chronic hepatitis C fully recover after an initial course of peginterferon and ribavirin antiviral therapy that can last from six months to a year. Other patients (non-responders) may show improvement, but the virus isn't eliminated.
The study included 1,050 non-responder patients with advanced liver disease. Half of them received low doses of peginterferon for 3.5 years to try to suppress the hepatitis C virus and slow progression of liver disease. The other patients were assigned to a control group.
After four years, 30 percent of patients in both groups had developed liver failure, liver cancer, or had died. Among those who had milder cirrhosis at the start of the study, 10 percent to 12 percent developed severe liver disease. Both of these findings surprised the researchers.
"Hepatitis patients in these circumstances got very ill over the course of four years, surprisingly so. The lesson we learned is that once chronic hepatitis C gets to the stage of advanced fibrosis, patients can decline rapidly," De Bisceglie said.
The study was published in the Dec. 4 issue of the New England Journal of Medicine.
About 4 million people in the United States are infected with hepatitis C, and 10,000 to 12,000 of them die each year. Hepatitis C is caused by virus that's transmitted through direct contact with an infected person's blood.
WEDNESDAY, Dec. 3 (HealthDay News) -- Maintenance therapy using low-dose peginterferon doesn't help patients with advanced chronic hepatitis C who haven't responded to an initial round of treatment, new research suggests.
The study also showed a surprising health decline in patients with liver disease over the course of four years.
"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. The treatment is clearly ineffective," study author Dr. Adrian Di Bisceglie, chief of hepatology and co-director of the Liver Center at Saint Louis University, said in a university news release.
About half of patients with chronic hepatitis C fully recover after an initial course of peginterferon and ribavirin antiviral therapy that can last from six months to a year. Other patients (non-responders) may show improvement, but the virus isn't eliminated.
The study included 1,050 non-responder patients with advanced liver disease. Half of them received low doses of peginterferon for 3.5 years to try to suppress the hepatitis C virus and slow progression of liver disease. The other patients were assigned to a control group.
After four years, 30 percent of patients in both groups had developed liver failure, liver cancer, or had died. Among those who had milder cirrhosis at the start of the study, 10 percent to 12 percent developed severe liver disease. Both of these findings surprised the researchers.
"Hepatitis patients in these circumstances got very ill over the course of four years, surprisingly so. The lesson we learned is that once chronic hepatitis C gets to the stage of advanced fibrosis, patients can decline rapidly," De Bisceglie said.
The study was published in the Dec. 4 issue of the New England Journal of Medicine.
About 4 million people in the United States are infected with hepatitis C, and 10,000 to 12,000 of them die each year. Hepatitis C is caused by virus that's transmitted through direct contact with an infected person's blood.
The HALT-C patients in that NEJM article were enrolled between Aug '00 and Aug '04 and treated for 3.5 years. I believe that article publishes data originally reported at AASLD'07 Here's a summary of an abstract from EASL'08 reporting data collected in the COPILOT study
http://www.hcvadvocate.org/news/reports/EASL_2008/Advocate%20EASL%202008%20Coverage.htm
Afdhal, lead author is quoted as reporting "These findings make a strong case for considering low-dose peginterferon alfa-2b as a maintenance therapy in patients with cirrhosis and portal hypertension who have failed hepatitis C eradication therapy"
also, the Bisceglie NEJM article note that "maintenance pegintron therapy was associated with significant decreases in serum HCV RNA levels, serum ALT levels and histologic necroinflammatory scores"
Overall it looks like maintenance does not seem to help with fibrosis progression or HCC risk but can be of benefit among the subset facing complications that accompany portal hypertension (and possibly other conditions - the AASLD'08 abstracts seem to have vaporized but I believe those would also be worth searching).
And I love that line about how peg "was generally well tolerated". Loosely translated, that means most patients stifled the urge to leave a truck load of fertilizer in the medical center parking lot.
http://www.hcvadvocate.org/news/reports/EASL_2008/Advocate%20EASL%202008%20Coverage.htm
Afdhal, lead author is quoted as reporting "These findings make a strong case for considering low-dose peginterferon alfa-2b as a maintenance therapy in patients with cirrhosis and portal hypertension who have failed hepatitis C eradication therapy"
also, the Bisceglie NEJM article note that "maintenance pegintron therapy was associated with significant decreases in serum HCV RNA levels, serum ALT levels and histologic necroinflammatory scores"
Overall it looks like maintenance does not seem to help with fibrosis progression or HCC risk but can be of benefit among the subset facing complications that accompany portal hypertension (and possibly other conditions - the AASLD'08 abstracts seem to have vaporized but I believe those would also be worth searching).
And I love that line about how peg "was generally well tolerated". Loosely translated, that means most patients stifled the urge to leave a truck load of fertilizer in the medical center parking lot.
For those that asked, Joe is as happy as anyone ever gets on interferon. :>) he is having some decent days right now...not good but decent.
The Dr in the above article, Dr.De Bisceglie, is in the same office that Joe goes too. They are involved in a lot of trials and seem to be on top of things. That being said, the P.A. had no qualms about Joe going on a while with the meds. If they were going to be a deadly poison to his cirrhotic liver, you would expect her to have immediately removed him at 24 weeks since they give him a 1% chance of success now. Somebody gets that 1% ...it could be Joe.
This is a very confusing disease isn't it. I need to take the rest of the day off from HCV and enjoy Joe's good mood while it lasts.
Ev
The Dr in the above article, Dr.De Bisceglie, is in the same office that Joe goes too. They are involved in a lot of trials and seem to be on top of things. That being said, the P.A. had no qualms about Joe going on a while with the meds. If they were going to be a deadly poison to his cirrhotic liver, you would expect her to have immediately removed him at 24 weeks since they give him a 1% chance of success now. Somebody gets that 1% ...it could be Joe.
This is a very confusing disease isn't it. I need to take the rest of the day off from HCV and enjoy Joe's good mood while it lasts.
Ev
Is this about non-responders? How about people that were rapid responders and relapsed?
Both articles seem to come from the "No Sh*t" Department of each publication.
Not knowing more of the facts, I'm not sure of the reasoning or viability behind the notion that maintenance therapy using low-dose peginterferon might work.
Anyone...?
It is like reinventing the wheel..but slower
Thank you for that information. Yo! Everybody listen the H*LL up! (I'm being sarcastic but in actuality being serious) ..... we have a research group who's come forward to conclude that maintenance isn't worth a sh** and in fact they're opining it might even take your butt outta this world a little faster (right?)
Nice.
Pick your poision? Is that what this sh** is?
Nice.
Pick your poision? Is that what this sh** is?
anyone seriously considering this should do a bit more research before committing. I haven't followed this closely but believe there are have been reports at both EASLD'08 and AASLD'08 contradicting the initial HALT-C reports reported ar AASLD'07.
Journal publication, and subsequent echoing by the media, can easily lag the conference presentation by a year. In other words, though this looks very recent, it may in fact be relatively outdated. Typically when contradictory results like this are reported, the devil is in the details - ie you need to slice the data more finely to see the effects. Remember Berg initially reported extending to 72-weeks had no value.
Journal publication, and subsequent echoing by the media, can easily lag the conference presentation by a year. In other words, though this looks very recent, it may in fact be relatively outdated. Typically when contradictory results like this are reported, the devil is in the details - ie you need to slice the data more finely to see the effects. Remember Berg initially reported extending to 72-weeks had no value.
Thanks for sharing the article -- very eye-opening and important information, especially when the current interferons can be so hard on the body and the psyche. I hope you and your husband are doing well and holding strong. All my best.
~eureka
~eureka
Thank you for inf. I am a non responder and there has been talk to consider low dose. No thanks
Hi Ev,
I just read essentially the same article in the NY Times. This echoes the results from the HALT-C studies, although his seems to paint a grimmer picture. I would discuss this with Joe’s doctor thoroughly before any decisions are made, though. I’m unsure that a general consensus has been reached on this subject. How is Joe holding up?
Bill
I just read essentially the same article in the NY Times. This echoes the results from the HALT-C studies, although his seems to paint a grimmer picture. I would discuss this with Joe’s doctor thoroughly before any decisions are made, though. I’m unsure that a general consensus has been reached on this subject. How is Joe holding up?
Bill
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