A virological response to pegylated-interferon and ribavirin is typically associated with a prompt fall in serum transaminases.
For some patients, transaminases rise during treatment.
Dr D. Thorburn and colleagues from Birmingham, UK assessed the frequency and defined factors associated with elevations of serum transaminases.
|35% of patients experienced transaminase elevations.|
| Alimentary Pharmacology & Therapeutics |
A total of 169 treated patients were studied.
Transaminase elevations were graded by WHO criteria - grade 0: no value > baseline, grade 1: 1-2x baseline, grade 2: 2.1-5x baseline, grade 3: >5x, grade 4: any rise with evidence of liver failure.
60/169 (35%) patients experienced transaminase elevations: 52 grade 1, 6 grade 2, 1 grade 3, 1 grade 4.
Overall, the end of treatment response and sustained virological response rates were 72% and 55%.
Lower rates were observed in the grade 1 elevation group (63% and 40%) compared with patients with grade 0 (79% and 65%) and grade ≥2 elevations (85% and 71%).
Grade 1 elevations tended to occur earlier during treatment than grade ≥2 elevations.
Transaminase elevations were associated with greater pre-treatment body weight (P = 0.006), steatosis (P = 0.008) and poorer sustained virological response rates (P = 0.007).
Dr Thorburn and the team found that transaminase elevations during treatment of chronic Hepatitis C virus with pegylated interferon and ribavirin were common but rarely severe.
He concluded, "Mild rises may reflect ongoing viral activity in treatment non-responders, however more significant rises are frequently observed despite a virological response, and may be because of an immuno-modulating effect of interferon in susceptible patients".