A group of international researchers evaluated the effect of pegylated (PEG) interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C.
Individual data from 3010 naive patients, with pretreatment and post-treatment biopsies from 4 randomized trials, were pooled.
Ten different regimens combining standard interferon, PEG interferon, and ribavirin were compared.
The impact of each regimen was estimated by the percentage of patients with at least one grade improvement in the necrosis and inflammation (METAVIR score).
It was also assessed by the percentage of patients with at least one stage worsening in fibrosis METAVIR score, and by the fibrosis progression rate per year.
Necrosis and inflammation improvement ranged from 39% (interferon, 24 weeks) to 73% (optimized PEG interferon and ribavirin).
Fibrosis worsening ranged from 23% (interferon, 24 weeks) to 8% (optimized PEG interferon and ribavirin).
The team found that all regimens significantly reduced the fibrosis progression rates in comparison to rates before treatment.
Furthermore, the reversal of cirrhosis was observed in 49% of 153 patients with baseline cirrhosis.
| Necrosis and inflammation improved by 73% with PEG interferon and ribavirin.
| Gastroenterology |
Six factors were found to be independently associated with the absence of significant fibrosis after treatment.
These included baseline fibrosis stage (odds ratio [OR] = 0.12), sustained viral response (OR = 0.36), and age less than 40 years (OR = 0.51).
The other associated factors were body mass index less than 27 kg/m2 (OR = 0.65), no or minimal baseline activity (OR = 0.70), and viral load less than 3.5 millions copies per milliliter (OR = 0.79).
Professor Thierry Poynard, of the University of Paris VI, Paris, France, concluded on behalf of the group, "PEG-interferon and ribavirin combination significantly reduces the rate of fibrosis progression in patients with hepatitis C."
In an accompanying Editorial, Professor Michael J.P. Arthur, of Southampton General Hospital, England, comments, "The study of Poynard et al. challenges all of us to accept that the traditional view of cirrhosis as a progressive, irreversible disease is no longer correct.
"This augurs well for the future of our patients with chronic HCV infection, particularly if they clear the virus with treatment," he adds.
"The study also encourages further scientific investigation of the key cell and molecular mechanisms of liver fibrosis.
"It raises the prospect that an antifibrotic agent, aimed at promoting regression of disease, may be an important therapeutic strategy for the future," he concludes.