Pegylated-interferon alpha 2b and ribavirin for recurrent hepatitis C: Methods (Part 2)

In: Recurrent hepatitis C

12 Sep 2012

ImmunosuppressionImmunosuppression was minimized before beginning PEG-IFN therapy and no patients at the time of treatment were on prednisone, mycophenolate mofetil or azathioprine. Seven patients were on cyclosporine monotherapy, three patients were on sirolimus monotherapy, two patients were on tacrolimus monotherapy and one patient was on a combination of tacrolimus and sirolimus.

Therapy was initiated an average of 24 months after transplantation (range six to 73 months). One patient had previously failed six months of standard interferon three times a week and ribavirin (Rebetron, Schering, Canada) after LT, and four patients were converted to PEG-IFN after five, nine, 10 and 12 months of Rebetron after LT (Table 1). The average starting dose of PEG-IFN was 0.91 pg/kg once weekly by subcutaneous injection (Table 2). The goal was to dose escalate PEG-IFN to 1.5 pg/kg weekly and to increase ribavirin to a minimum of 10.6 mg/kg daily. It was intended that all patients would be treated with 48 weeks of therapy regardless of HCV genotype. One patient, who was experiencing significant hemolysis on Rebetron, was converted to PEG-IFN monotherapy. The other 12 patients received a combination of PEG-IFN and ribavirin.

TABLE 2 The starting and maximum doses of pegylated-interferon alpha 2b (PEG-IFN) achieved and the impact of therapy on neutrophil and platelet counts

Patient PEG-IFN start (^g/kg) PEG-IFN maximum (^g/kg) PMN start (X109/L) PMN low (X109/L) Platelets start (X109/L) Platelets low (X109/L)
11 0.47 0.47 3.7 3.3 108 71
12 0.88 0.88 2.2 0.6* 138 83
5 0.93 0.93 1.5 0.5* 252 155
13 0.97 0.97 3.0 0.7* 61 26t
6* 0.49 0.98 3.2 1.6 115 46t
10 1.04 1.04 1.8 1.6 139 139
3 1.05 1.05 0.9 0.4* 78 58
1* 1.07 1.07 3.0 0.9* 176 72
7 1.07 1.07 1.3 0.6* 60 41t
9 1.07 1.07 4.2 1.6 207 153
2* 0.86 1.38 1.5 1.1 123 70
4* 1.00 1.48§ 2.5 1.4 318 162
8 0.99 1.48§ 1.9 0.7* 151 97
Average 0.91 1.07 2.36 1.15 148 90.2

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