THE EFFICACY OF THE PEGINTERFERON TREATMENT IN CHRONIC HEPATITIS HDV AND COMPENSATE LIVER CIRRHOSIS

Authors

  • Letitia TUGUI Fundeni Clinical Institute, Bucharest
  • M. DUMITRU Pediatrics Department I.O.M.C. “A.Rusescu”
  • Speranta IACOB Fundeni Clinical Institute, Bucharest
  • Liana GHEORGHE Fundeni Clinical Institute, Bucharest
  • Carmen PREDA Fundeni Clinical Institute, Bucharest
  • Ioana DINU University of Medicine and Pharmacy ”Carol Davila” – Bucharest
  • G. BECHEANU University of Medicine and Pharmacy ”Carol Davila” – Bucharest
  • Mona DUMBRAVA University of Medicine and Pharmacy ”Carol Davila” – Bucharest
  • Ioana NICOLAE Fundeni Clinical Institute, Bucharest
  • Adriana ANDREI Fundeni Clinical Institute, Bucharest
  • A. LUPU Fundeni Clinical Institute, Bucharest
  • M. DICULESCU Fundeni Clinical Institute, Bucharest

Abstract

Aim: to evaluate the efficiency of the treatment with Peginterferon alfa 2a 180 mcg/week, 48 weeks in patients with chronic hepatitis or compensated liver cirrhosis HDV and predictive factors of response to treatment. Material and methods: prospective study that enrolled 50 patients with chronic hepatitis or compensated cirrhosis HDV between the 1st of January 2011 – 3st of December 2011. The diagnosis of chronic HDV infection was made based on the presence of detectable anti HDV IgG antibodies and HDV-RNA. Patients were evaluated at baseline by CBC, liver function tests, HBV profile, HDV RNA, and by liver biopsy/Fibrotest for evaluating fibrosis and necroinflamatory activity. At 24 weeks CBC (count blood cells), liver function tests, quantitative HBsAg and at 48 and 72 weeks biochemical tests, HDV RNA, HBV DNA, quantitative HBsAg, were performed. Adverse reactions to the treatment were recorded. Results: SVR (sustained virologic response) was recorded in 12 patients (24%) and biochemical response in 28 patients (56%). SVR was correlated with low-grade fibrosis, age, the aminotransferase value and the value of HBsAg at the beginning of the treatment. In week 48 HDV RNA was undetectable in 20 patients (40%). The therapy was well tolerated, except two patients for whom the discontinuation of the treatment was decided for severe exacerbation of cytolysis, respectively hepatic decompensation. Conclusions: In a representative group of patients, the treatment with Peginterferon once again proves its efficacy in treating chronic HDV.

Author Biographies

  • Letitia TUGUI, Fundeni Clinical Institute, Bucharest

    Gastroenterology and Hepatology Clinic

  • Speranta IACOB, Fundeni Clinical Institute, Bucharest

    Gastroenterology and Hepatology Clinic

  • Liana GHEORGHE, Fundeni Clinical Institute, Bucharest

    Gastroenterology and Hepatology Clinic

  • Carmen PREDA, Fundeni Clinical Institute, Bucharest

    Gastroenterology and Hepatology Clinic

  • Ioana DINU, University of Medicine and Pharmacy ”Carol Davila” – Bucharest

    Oncology Department

  • G. BECHEANU, University of Medicine and Pharmacy ”Carol Davila” – Bucharest

    Pathology Department

  • Mona DUMBRAVA, University of Medicine and Pharmacy ”Carol Davila” – Bucharest

    Pathology Department

  • Ioana NICOLAE, Fundeni Clinical Institute, Bucharest

    Gastroenterology and Hepatology Clinic

  • Adriana ANDREI, Fundeni Clinical Institute, Bucharest

    Gastroenterology and Hepatology Clinic

  • A. LUPU, Fundeni Clinical Institute, Bucharest

    Gastroenterology and Hepatology Clinic

  • M. DICULESCU, Fundeni Clinical Institute, Bucharest

    Gastroenterology and Hepatology Clinic

References

1. Fattovich G, Boscaro S, Noventa F, et al. Influence of hepatitis delta virus infection on progression to cirrhosis in chronic hepatitis type B. J Infect Dis 1987; 155: 931–935.
2. L Gheorghe, S .Iacob, I.Simionov et al. Natural history of compensated viral B and D cirrhosis. Ro-manian J Gastroenterol 2005: 14(4): 329-335.
3. Gunsar F. Treatment of delta hepatitis. Expert Rev Anti Infe Ther 2013; 11(5): 489-498.
4. Rizzetto M. Hepatitis D: thirty yers after. J.Hepatol 2009; 50(5): 1043-1050.
5. Janssen HLA, Brouwer JT, Nevens F, et al. Fatal hepatic decompensation associated with interferon alfa. BMJ 1993; 306: 107-108.
6. Flink HJ, Sprengers D, Hansen BE, et al. Flares in chronic hepatitis B patients induced by the host or the virus? Relation to treatment response during Peg interferon (alpha)-2b therapy. Gut 2005; 54: 1604-1609.
7. Sonneveld MJ, Rijckborst V, Boucher CA, Hansen BE, Janssen HL. Prediction of sustained response to peginterferon alfa-2b for hepatitis B e antigen-positive chronic hepatitis B using on-treatment hepatitis B surface antigen decline. Hepatol 2010; 52:1251-1257.
8. Niro GA, Ciancio A, Gaeta GB, Smedile A, Marrone A, Olivero A, et al. Pegylated interferon alpha-2b as monotherapy or in combination with ribavirin in chronic hepatitis delta. Hepatol 2006; 44: 713-720.
9. Wedemeyer H, Yurdaydìn C, Dalekos GN, Erhardt A, Çakaloğlu Y, Değertekin H et al.. Peginterferon plus adefovir versus either drug alone for hepatitis delta. N Engl J Med 2011; 364: 322-33.
10. Erhardt A, Gerlich W, Starke C, Wend U, Donner A, Sagir A, Heintges T, Häussinger D. Treatment of chronic hepatitis delta with pegylated interferon-alpha2b. Liver Int 2006; 26: 805-810.
11. Castelnau C, Le Gal F, Ripault MP, Gordien E, Martinot-Peignoux M, Boyer N, Pham BN, Maylin S, Bedossa P, Dény P, Marcellin P, Gault E. Efficacy of peginterferon alpha-2b in chronic hepatitis delta: relevance of quantitative RT-PCR for follow-up. Hepatol 2006; 44: 728-735.
12. Zachou K, Yurdaydin C, Drebber U, Dalekos GN, Erhardt A, Cakaloglu Y, et al. Quantitative HBsAg and HDV-RNA levels in chronic delta hepatitis. Liver Int 2010; 30: 430-437.
13. Rosina F, Pintus C, Meschievitz C, Rizzetto M. A randomized controlled trial of a 12-month course of recombinant human interferon-alpha in chronic delta (type D) hepatitis: a multicenter Italian study. Hepatol 1991; 13: 1052-1056.
14. Yurdaydin C, Bozkaya H, Onder FO, et al. Treatment of chronic delta hepatitis with lamivudine vs lamivudine + interferon vs interferon. J Viral Hepat 2008; 15: 314–321.
15. Marzano A, Ottobrelli A, Spezia C, Daziano E, Soranzo ML, Rizzetto M. Treatment of early chronic delta hepatitis with lymphoblastoid alpha interferon: a pilot study. Ital J Gastroenterol 1992; 24: 119–121.
16. Hughes S, Carey I, Shang D, et al. Hepatitis delta virus RNA level and IgM antibody titer predict response to Peg-interferon therapy (abstract). Hepatol 2009; 50(Suppl. 4): 735A.
17. Yurdaydin C, Kabacam G, Cakaloglu Y, et al. Efficacy of pegylated interferon 0[based treatment in patients with cirrhosis due to chronic delta hepatitis: comparison with non-cirrhotic patients (abstract). Hepatol 2009; 50(Suppl. 4): 736A.
18. Farci P, Mandas A, Coiana A, et al.Treatment of chronic hepatitis D with interferon alfa-2a. N Engl J Med 1994; 330: 88–94.

Additional Files

Published

2018-05-03

Issue

Section

INTERNAL MEDICINE - PEDIATRICS