Impact of interferon alfa-2b and ribavirin on progression of liver fibrosis in patients with chronic hepatitis C



The extent of liver fibrosis is an important prognostic factor in patients infected with hepatitis C virus. Administration of a combination of interferon and ribavirin produces a superior viral clearance response rate than interferon alone. The effect of this combination regimen on hepatic fibrosis has not been established. To determine the impact of combination regimen or interferon alone on the progression of liver fibrosis we pooled individual data of 1,509 patients with pretreatment and post-treatment biopsies from 3 randomized trials. Fibrosis progression and regression rates between biopsies were calculated by the Kaplan-Meier method and by the fibrosis progression rate per year. The percentage of patients without significant fibrosis (stage 0 or 1) at 96 weeks was 68 ± 4% (mean ± SE) when treated by combination regimen for 48 weeks, 64 ± 4% by interferon alone for 48 weeks, 42 ± 7% by combination regimen for 24 weeks (lower than both 48-week regimens P < .001), and 24 ± 9% interferon alone for 24 weeks (lower than the combination regimen for 24 weeks; P = .02). Three factors were independently associated with fibrosis reduction: sustained viral response, duration of treatment, and baseline fibrosis stage (all P < .001 in proportional hazards regression model). These results show that interferon and ribavirin combination therapy significantly reduces the rate of fibrosis progression in patients with hepatitis C. This effect was most prominent in patients who achieved a virologic response, those receiving 48 weeks of therapy, and in patients with significant fibrosis at baseline.