Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 17 January 2018

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Iron reduction improves interferon therapy response in chronic hepatitis C patients

Iron removal by phlebotomy improves the rate of response to interferon therapy in patients with chronic hepatitis C, claim researchers from Italy.

News image

fiogf49gjkf04

The team evaluated whether iron reduction by phlebotomy, before interferon-alpha therapy, improves virological sustained response in previously untreated, non-cirrhotic patients with chronic hepatitis C.

The findings of the research were published in the May issue of the American Journal of Gastroenterology.

A total of 114 hepatitis C virus (HCV) RNA-positive patients with hepatic iron concentrations of ≥ 700 µg/g dry wt (men) and ≥ 500 µg/g dry wt (women) were included in the study.

They were stratified according to HCV genotype and gamma-glutamyltransferase values.

The patients were then randomly allocated to interferon alone (6 MU, 3 times a week, Group A) or to phlebotomy until iron depletion followed by interferon (6 MU, 3 times a week, Group B).

After 4 months, the dosage was reduced to 3 MU, 3 times a week, for another 8 months.

Virological sustained response was observed in 25 patients (22%) - 9 (16%) of Group A and 16 (28%) of Group B.

At univariate analysis, the variables found to be associated with the response were HCV genotypes 2-3 and normal gamma-glutamyltransferase.

Higher levels of baseline ALT, normal ALT values, and negativity for HCV-RNA at the 3rd month of therapy were also linked with response.

At multivariate analysis, HCV genotype and ALT levels at enrollment maintained their association with the response.

Iron reduction improved response to interferon therapy by over 2-fold.
American Journal of Gastroenterology

The authors discovered that a trend toward a better response to interferon was observed in patients who received phlebotomy (odds ratio = 2.32).

Furthermore, patients with hepatic iron concentration of ≤ 1100 µg/g dry wt had a trend toward a higher rate of virological sustained response when submitted to treatment B.

Silvia Fargion, of the University of Milan, concluded on behalf of fellow authors, "Iron removal by phlebotomy is able to improve the rate of response to interferon, especially in patients with lower hepatic iron deposits.

"It could be useful as adjuvant therapy to new therapeutic modalities."

In an accompanying Editorial, Steven I. Shedlofsky, of the University of Kentucky, Lexington, Kentucky, USA, comments, "The role for routine iron reduction in the therapy of hepatitis C patients remains controversial and is not advocated or mentioned in current reviews of HCV therapy.

"This may be because modern evidence-based medicine requires stronger proof of efficacy than what is currently published, and cannot recommend based on the purely theoretical benefits of iron reduction."

"However, there may also be a bias against using therapies for hepatitis C that are not directed at eradication of virus," he adds.

Nonetheless, in the absence of "official" recommendations, Dr Shedlofsky advocates phlebotomy in all non-acutely ill HCV patients with serum ferritins of < 200 ng/ml.

He concludes that, "Iron reduction using phlebotomy as non-eradicative therapy is safe and relatively inexpensive. It offers potential benefit even if the patient is not a candidate for, cannot tolerate, or failed interferon-ribavirin therapy."

Am J Gastroenterol 2002; 97(5): 1093-6, 1204-10
07 June 2002

Go to top of page Email this page Email this page to a colleague

 17 January 2018 
“Weekend effect” in upper GI hemorrhage
 17 January 2018 
Gut dysbiosis and non-antibiotic prescription medications
 17 January 2018 
Reducing surgical infections in high-outlier colorectal unit
 16 January 2018 
Bundle of care in GI cancer surgery
 16 January 2018 
Anxiety about colonoscopy
 16 January 2018 
Thiopurines and colorectal neoplasia in IBD
 15 January 2018 
Risks of death after liver transplants for liver cancer
 15 January 2018 
Recent advances in hepatocellular carcinoma
 15 January 2018 
Ileostomy output using telemedicine
 12 January 2018 
Surveillance protocols after colorectal cancer resection
 12 January 2018 
Biologic therapy by pregnant women with IBD and infant vaccines
 12 January 2018 
Biologic therapies for IBD in the USA
 11 January 2018 
Genetic risk factors in GERD
 11 January 2018 
Predictor of colorectal adenoma
 11 January 2018 
Ectopic pregnancy in IBD 
 10 January 2018 
Fecal immunochemical tests for colorectal cancer screening
 10 January 2018 
Risk factors for advanced NAFLD
 10 January 2018 
Dyspepsia prevalence with gastroesophageal reflux–type symptoms
 09 January 2018 
Screening intervals for people with family histories of colorectal cancer
 09 January 2018 
Financial impact of colorectal cancer
 09 January 2018 
Current practice and future research in autoimmune hepatitis
 08 January 2018 
Improving prognosis in patients with primary sclerosing cholangitis
 08 January 2018 
Reliability of the IBD index
 08 January 2018 
Aprepitant and nausea with gastroparesis
 05 January 2018 
Autoimmune pancreatitis and IBD
 05 January 2018 
Primary nonresponse to infliximab therapy
 05 January 2018 
Anesthesia assistance in outpatient colonoscopy
 04 January 2018 
Dietary polyphenols in the etiology of IBD
 04 January 2018 
Yoga vs low-FODMAP in IBS
 04 January 2018 
Local esophageal food allergen injections in eosinophilic esophagitis
 03 January 2018 
Population health management for IBD
 03 January 2018 
GERD in asthma and COPD
 03 January 2018 
Critical research gaps in colorectal cancer
 22 December 2017 
Costs of extrahepatic manifestations of Hep C
 22 December 2017 
Cholera vaccine and risk of death in colorectal cancer
 22 December 2017 
Colonoscopy after colorectal cancer resection
 21 December 2017 
Human oral microbiome and pancreatic cancer risk
 21 December 2017 
Health management for IBD
 21 December 2017 
PPI and Alzheimer's disease
 20 December 2017 
Incidence of biopsy-verified celiac disease
 20 December 2017 
Osteoporotic fractures in Barrett's esophagus
 20 December 2017 
Management of abnormal liver blood tests
 19 December 2017 
Family burden of pediatric Crohn's in the USA
 19 December 2017 
Alcohol abstinence and alcoholic hepatitis
 19 December 2017 
Early readmission in IBD patients
 18 December 2017 
Colorectal cancer mortality with low-risk adenomas at colonoscopy
 18 December 2017 
Disease activity indices in celiac disease
 18 December 2017 
Smoking behaviour predicted the risk of surgery in Crohn's
 15 December 2017 
Molecular classification of Crohn's disease
 15 December 2017 
Medical cannabinoid legalization policy and vomiting
 15 December 2017 
Inflammatory diet pattern and colorectal cancer risk
 14 December 2017 
PPIs and gastric cancer after H.pylori eradication
 14 December 2017 
H. pylori eradication therapies in countries with clarithromycin resistance
 13 December 2017 
Disease severity in NAFLD
 13 December 2017 
Tryptophan metabolism and IBD activity
 12 December 2017 
Risk factors in undiagnosed cirrhosis
 12 December 2017 
Monitored anesthesia care for outpatient GI endoscopy
 12 December 2017 
High-risk colorectal cancer patients
 06 December 2017 
Reflux-induced chronic cough 
 06 December 2017 
Systemic inflammatory response syndrome in acute-on-chronic liver failure

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2018 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us