Reduction in hepatic inflammation associated with less fibrosis progression in HCV

Reduction in hepatic inflammation is associated with less fibrosis progression in HCV

Reduction in hepatic inflammation is associated with less fibrosis progression and fewer clinical outcomes in advanced Hepatitis C, finds the most recent issue of the American Journal of Gastroenterology.

During the Hepatitis C Antiviral Long-term Treatment against Cirrhosis Trial, 3.5 years of maintenance peginterferon-alfa-2a therapy did not affect liver fibrosis progression or clinical outcomes among 1,050 previous interferon nonresponders with advanced fibrosis or cirrhosis.

Dr Chihiro Morishima and colleagues from Washington, USA investigated whether reduced hepatic inflammation was associated with clinical benefit in 834 patients with a baseline and follow-up biopsy 1.5 years after randomization to peginterferon or observation.

Relationships between change in hepatic inflammation, and serum alanine aminotransferase level, fibrosis progression and clinical outcomes after randomization, and hepatitis C virus (HCV) RNA decline before and after randomization were evaluated.

The researchers defined histological change a 2-point or more difference in Ishak hepatic activity index or Ishak fibrosis score between biopsies.

Among 657 patients who received full-dose peginterferon/ribavirin 'lead-in' therapy before randomization, year-1.5 Ishak hepatic activity index improvement was associated with lead-in HCV RNA suppression in both the randomized treated and control groups, even in the presence of recurrent viremia.

This relationship persisted at year 3.5 in both the treated and control groups.

The research team found that among 834 patients followed for a median of 6 years, fewer clinical outcomes occurred in patients with improved Ishak hepatic activity index at year 1.5 compared with those without such improvement in both the treated and control groups.

Among patients with Ishak 3–4 fibrosis at baseline, the team noted that those with improved Ishak hepatic activity index at year 1.5 had less fibrosis progression at year 1.5 in both the treated and control groups.

Dr Morishima's team commented, "Reduced hepatic inflammation was associated with profound virological suppression during lead-in treatment with full-dose peginterferon/ribavirin and with decreased fibrosis progression and clinical outcomes, independent of randomized treatment."

Am J Gastroenterol 2012; 107:1388–1398 24 September 2012