Monday, July 30, 2012

Most Chronic Hepatitis C Patients Report Fatigue

NEW YORK (Reuters Health) Jul 27 - More than 50% of patients with chronic hepatitis C suffer from fatigue, which in many cases would improve with antiviral therapy, a new paper says.
The authors say their data "indicate that therapy of HCV can result in significant and sustained improvement in clinical symptoms, and that the measurement of fatigue using visual analog scales is successful in capturing these changes."

"Thus, patients with relatively nonsignificant biochemical or histologic disease, but who have troublesome symptoms such as fatigue, should be considered for antiviral therapy," Dr. Jay H. Hoofnagle from National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland and colleagues wrote online June 30th in the Journal of Hepatology.

On the other hand, they caution, "Improvements in fatigue scores were seen predominantly among patients who had moderate or severe levels of fatigue before treatment, and there was little or no improvement in patients who reported minimal fatigue initially. Such findings suggest that there is little room for improvement in fatigue among those with lower levels at baseline, or that the visual analog scale is not sensitive enough to detect minor improvements."

Their conclusions are drawn from the multicenter Virahep-C study, in which 401 patients with chronic hepatitis C, genotype 1 received peginterferon alfa-2a and ribavirin with extensive monitoring of HCV viral kinetics, immune function, genetics and interferon signaling pathways.
Treatment continued for up to 48 weeks. Just over half of the patients (207/401, 52%) reported fatigue at the time of screening. The prevalence and severity of fatigue were higher for women than for men, and fatigue was more common in patients with cirrhosis (66%) than in those with minimal (49%) or moderate fibrosis (53%).

In multivariate analysis at screening, younger age and lower alanine aminotransferase level were the only factors independently associated with more severe fatigue.

During treatment, the prevalence of fatigue increased from 52% to 78% at week four and ranged from 67% to 79% for the duration of treatment.

By 12 weeks after the end of therapy, the prevalence of fatigue had declined to 36% in responders and 42% in nonresponders, and the median fatigue visual analog scores had declined from 25 mm at baseline to 11 mm in responders and 17 mm in nonresponders.

Fatigue improved to a significantly greater extent among patients who achieved a sustained virologic response than among patients who never became HCV RNA negative (nonresponders).
However, the presence or severity of fatigue did not change significantly among patients who had virologic relapse or breakthrough.

Fatigue scores were associated with depression, but controlling for the presence of depression did not alter the significance of the improvements in fatigue severity after successful completion of therapy.
Dr. Hoofnagle did not respond to a request for comments.

J Hepatol 2012.

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