Efficacy of interferon based antiviral therapy for recurrent hepatitis C in patients who received steroid free immunosuppression for liver transplantation

BACKGROUND: In this article, we explore the virological response to two types of interferon based treatment in recurrent hepatitis C virus in liver recipients who received thymoglobulin induction. METHODS: Fifty consecutive patients were randomized to receive PEG interferon alpha 2b (1.0 microg/kg per week), ribavirin (800 mg/d) plus amantadine (200 mg/d), or PEG interferon alpha 2b (1.0 microg/kg per week) plus ribavirin (800 mg/d). The primary endpoint was absence of hepatitis C virus RNA 6 months posttreatment. The secondary endpoint was change in fibrosis at 1 year. RESULTS: Only 30 patients completed 1 year of treatment. In an intention to treat analysis, the sustained virological response (SVR) rate was 26% in I/R/A group and 50% in I/R group. By per protocol, the overall SVR rate was 57%. Fibrosis progression by at least one stage was noted in 37% patients. Twenty-nine percent of patients who achieved SVR had shown fibrosis progression by at least one stage whereas 46% nonresponders showed fibrosis progression (P=NS). CONCLUSION: This is the first study exploring the efficacy of pegylated interferon-based antiviral treatment in patients who received a steroid-free protocol. Our data is encouraging and shows that if liver transplant recipients can tolerate treatment for 1 year there is a reasonable chance of SVR.