Meta-analysis: interferon for the treatment of chronic hepatitis C in dialysis patients
Article first published online: 14 NOV 2003
Alimentary Pharmacology & Therapeutics
Volume 18, Issue 11-12, pages 1071–1081, December 2003
How to Cite
Fabrizi, F., Dulai, G., Dixit, V., Bunnapradist, S. and Martin, P. (2003), Meta-analysis: interferon for the treatment of chronic hepatitis C in dialysis patients. Alimentary Pharmacology & Therapeutics, 18: 1071–1081. doi: 10.1046/j.1365-2036.2003.01780.x
- Issue published online: 20 NOV 2003
- Article first published online: 14 NOV 2003
- Accepted for publication 15 August 2003
Background : The efficacy of interferon monotherapy in dialysis patients with chronic hepatitis C remains unclear, although a number of small clinical trials have been published addressing this issue.
Methods and aims : We evaluated the efficacy and safety of initial interferon monotherapy in dialysis patients with chronic hepatitis C by performing a systematic review of the literature with a meta-analysis of clinical trials. The primary outcome was sustained virological response (as a measure of efficacy); the secondary outcome was drop-out rate (as a measure of tolerability). We used the random effects model of Der Simonian and Laird, with heterogeneity and sensitivity analyses.
Results : We have identified 14 clinical trials (269 unique patients); two were controlled studies. The mean overall estimate for sustained virological response (SVR) and drop-out rate was 37%[95% confidence interval (CI) 28–48] and 17% (95% CI 10–28), respectively. The most frequent side-effects requiring interruption of treatment were flu-like symptoms (17%), neurological (21%) and gastrointestinal (18%). The overall weighted estimate for SVR in patients with hepatitis C virus genotype 1 was 30.6% (95% CI 20.9–48). In the sub-group of clinical trials (n = 5) with standard interferon administration (3 million units [MUI] thrice weekly, subcutaneous route, 24-week treatment), the overall mean estimate of SVR was 39% (95% CI 25–56). The studies were heterogeneous with regard to SVR and drop-out rate.
Conclusions : Tolerance to initial interferon monotherapy was lower in dialysis than nonuremic patients with chronic hepatitis C. However, more than one-third of haemodialysis patients with chronic hepatitis C have been successfully treated with interferon. Longer duration of interferon monotherapy does not appear to have a beneficial effect on the response rate. Further studies are warranted to define the optimal anti-viral regimen for chronic hepatitis C in dialysis population.