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 Thorburn and colleagues from Birmingham, England 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 had no increased value from baseline, while Grade 1 was 1 to 2 times the value of baseline.
Grade 2 was 2 to 5 times above baseline, and Grade 3 was 5 times above baseline values.
Grade 4 included any rise with evidence of liver failure.
The team found that 35% of patients experienced transaminase elevations.
The team noted that 52 patients were classed as Grade 1, 6 as Grade 2, 1 as Grade 3, and another as Grade 4.
Overall, the end of treatment response and sustained virological response rates were 72% and 55%, respectively.
The team observed lower rates in the Grade 1 elevation group vs those with Grade 0 and Grade 2 elevations or more.
Grade 1 elevations tended to occur earlier during treatment than with Grade 2 elevations or above.
Transaminase elevations were associated with greater pre-treatment body weight, steatosis, and poorer sustained virological response rates.
Dr Thorburn and the team commented, "Transaminase elevations during treatment of chronic Hepatitis C virus with pegylated interferon and ribavirin were common but rarely severe."
"Mild rises may reflect ongoing viral activity in treatment non-responders."
"However more significant rises are frequently observed despite a virological response."
"This may be because of an immuno-modulating effect of interferon in susceptible patients".