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Pegylated Interferon With or Without Ribavirin for Patients With Hepatitis C Receiving Hemodialysis FREE

[+] Article and Author Information

The full report is titled “Pegylated Interferon-α2a With or Without Low-Dose Ribavirin for Treatment-Naive Patients With Hepatitis C Virus Genotype 1 Receiving Hemodialysis. A Randomized Trial.” It is in the 3 December 2013 issue of Annals of Internal Medicine (volume 159, pages 729-738). The authors are C.H. Liu, C.F. Huang, C.J. Liu, C.Y. Dai, C.C. Liang, J.F. Huang, P.H. Hung, H.B. Tsai, M.K. Tsai, S.I. Chen, J.W. Lin, S.S. Yang, T.H. Su, H.C. Yang, P.J. Chen, D.S. Chen, W.L. Chuang, M.L. Yu, and J.H. Kao.


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Ann Intern Med. 2013;159(11):I-14. doi:10.7326/0003-4819-159-11-201312030-00001
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What is the problem and what is known about it so far?

Patients receiving hemodialysis often have hepatitis C. The drug ribavirin, when added to standard interferon-based therapy, has been shown to improve responses to hepatitis C treatment. However, ribavirin has been considered contraindicated in patients with hepatitis C receiving hemodialysis because of concerns about the risk for anemia with this drug.

Why did the researchers do this particular study?

To see whether patients with hepatitis C receiving hemodialysis, when carefully monitored and treated for anemia, could tolerate and benefit from the addition of ribavirin to pegylated interferon-α2a therapy.

Who was studied?

Patients in Taiwan with chronic hepatitis C who were receiving hemodialysis for end-stage renal disease and had not yet been treated for hepatitis C.

How was the study done?

Patients were randomly assigned to receive either low-dose ribavirin plus pegylated interferon-α2a or pegylated interferon-α2a alone. They were monitored for side effects. If anemia developed, they received epoetin, a drug that treats anemia.

What did the researchers find?

Patients who received both low-dose ribavirin and pegylated interferon-α2a were more likely to have suppression of their hepatitis C infection than those who received pegylated interferon-α2a alone, and the degree of response was very similar to that of patients with hepatitis C and normal renal function. Patients receiving ribavirin were more likely to develop anemia and required more epoetin and for a longer time than patients receiving pegylated interferon-α2a alone. Otherwise, adverse events were similar in the 2 groups. One patient receiving both ribavirin and pegylated interferon-α2a died of an allergic drug reaction called the Stevens–Johnson syndrome. This syndrome has also been seen in the past in patients receiving pegylated interferon drugs alone. The relatively small number of patients in the trial did not allow researchers to determine whether the risk for the syndrome is actually greater with both ribavirin and pegylated interferon-α2a than with pegylated interferon-α2a alone.

What were the limitations of the study?

The study was done in Taiwan, and patients of Asian ancestry generally have better responses to hepatitis C treatment. The study did not include patients with renal failure on peritoneal dialysis.

What are the implications of the study?

With careful monitoring and use of a drug to treat anemia, patients with hepatitis C receiving hemodialysis may be able to tolerate ribavirin in combination with pegylated interferon-α2a, which will generally improve their therapeutic responses.

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