Antivirals May Reverse Hepatitis C Cirrhosis

NAPLES, Italy, Oct. 11 -- Long-term antiviral treatment may partly reverse liver cirrhosis in patients with chronic hepatitis C, researchers here said.

In a pilot cohort study of 71 patients with compensated cirrhosis, those who were treated with interferon-alpha and ribavirin were significantly more likely to see improved liver function than those who did not receive the treatment, Giovanni Tarantino, M.D., of Federico II University Medical School of Naples, and colleagues reported in the October issue of the World Journal of Gastroenterology.

While the study was not randomized or controlled, the researchers said it suggests that a "prolonged combined antiviral course at reduced doses may slow down the progression of liver disease to cirrhosis."

In the study, Dr. Tarantino and colleagues treated 35 of the 71 patients for a median of 31 months with "moderate doses" of interferon and ribavirin. Eight patients received 1.5 MU daily of interferon-alpha, 13 received 3.0 MU every second day, and 14 were given pegylated interferon alpha 2b weekly at one microgram per kilogram of body weight. Oral ribavirin was given at 400 milligrams a day for those weighing less than 75 kilograms and 600 milligrams for heavier patients.

The remaining 36 patients were not treated for reasons ranging from simple refusal to contraindication, the researchers said. The two groups were otherwise similar, they said.

In the treated group, 24 patients were grade A5 and 11 were grade A6 on the Child-Pugh classification scale. Among the untreated group, the numbers were 25 and 11, respectively.

The primary endpoint was liver function, as measured by total overnight salivary caffeine assessment (or TOSCA) - a method comparable to the caffeine clearance test. Patients were allowed to drink coffee until late afternoon and a sample of saliva was collected for analysis after an overnight intake-washout.

The TOSCA test was performed at baseline and three more times during the follow-up.

The researchers also measured the resistive index of the splenic artery using Doppler ultrasound.

They found:

• In the treated group, six out of the 24 A5 patients (25%) and four out of the 11 A6 patients (36.4%) showed an improvement of more than 20% over baseline TOSCA scores. The improvement was significant at P=0.0001.
• In the untreated group, five of the 36 patients (13.9%) saw their TOSCA values worsen.
• One patient in the treated group had a worsening in Child-Pugh classification, compared with eight of those in the untreated group. The difference was significant at P=0.04.

The researchers noted that prolonged stable cirrhosis and some possible improvements would have a benefit in terms of reduced costs for hospital care and transplantation.