icon_folder.gif   Conference Reports for NATAP  
 
  AASLD ( American Association for the Study of Liver Diseases)
 
November 9-13, 2001, Dallas
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Abstract 625. EFFECT OF INTERFERON AND RIBAVIRIN ON PROGRESSION OF LIVER FIBROSIS IN PATIENTS WITH SEVERE CHRONIC HEPATITIS C.
 
Reported by Jules Levin
 
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Armand Abergel, Corinne Bonny, HTMtel Dieu, Clermont Ferrand France; Sylvie Ughetto, Claude Darcha, Htmtel Dieu Blvd Leon Malfrey, Clermont Ferrand France; Michelle Chevalier, Inst Merieux, Lyon France; Cecile Henquell, CHU Place Henri Dunant, Clermont Ferrand France; Nathalie Martineau, Karine Randl, HTMtel Dieu Blvd Leon Malfrey, Clermont Ferrand France; Helene Lafeuille, Bruno Aublet-Cuvelier, CHU Place Henri Dunant, Clermont Ferrand France; Gilles Bommelaer, HTMtel Dieu Blvd Leon Malfrey, Clermont Ferrand France
 
These study investigators report finding improved fibrosis progression following HCV therapy in patients with advanced liver disease (stage 3/4). For nonresponders, fibrosis progression reversed, and for nonresponders progression slowed.
 
Several studies have shown that treatment with interferon plus ribavirin can lead to sustained virological response in patients with chronic hepatitis C. Poynard et al (Hepatology 2000;32:1131-7) assessed the effect of this combination regimen on hepatic fibrosis but included few cirrhotic patients.
 
The aim of our study was to determine the impact of interferon and ribavirin (IR) combination on the progression of liver fibrosis in patients with severe chronic hepatitis C (Knodell fibrosis score = 3 or 4).
 
Patients : Two hundred patients with severe chronic hepatitis C were enrolled in 2 trials between 1996 and 1998. 75 patients received interferon (I) during 12 months and ribavirine (R) during 6 months (Group A); 75 were treated by I alone during 12 months (Group B) and 50 by a combination of IR during 12 months (Group C). There were no statistically significant difference between the groups A and C for age, ALT, viremia, genotypes, liver histology according to Knodell. Gender was significantly different between groups A and C (56% men in the group A and 75% in the group C; p=0.053).All the samples of liver were read by 2 pathologists (CD, MC). Fibrosis stage were expressed in Knodell and Metavir units. Fibrosis progression rate was assessed using Metavir units (fibrosis score/number of years from the contamination or fibrosis score/time between 2 biopsies). In this study we compared histologic improvment between IR combination Group (A+C) and I alone (Group B) in patients with a known source of infection. Assessment was done in 76 patients and based on biopsy realised before and after treatment.
 
Results :The means of the scores of fibrosis progression before treatment were respectively of 0.26 (mediane 0.184) and 0.212 (mediane 0.186) in the combination group and in the interferon group. The means of the scores of fibrosis progression after treatment were respectively of -0.141 (mediane 0) and - 0.127 (mediane 0) in the combination group and in the interferon group. The fibrosis progression before and after treatment (progression before - progression after treatment) were not statistically different between the IR and I groups. The means of fibrosis progression in the patients treated by the combination regimen were of -0.333 (mediane 0) in patients with sustained response and of 0.017 (mediane 0) in non responders (Wilcoxon test: p< 0.002). The means of fibrosis progression in the group of patients treated by I alone were of -0.4 (mediane 0) in patients with sustained response and of -0.042 (mediane 0) in non responders (p < 0.02). Conclusions: 1) Interferon alone and the interferon-ribavirine combination decreased fibrosis progression in patients with severe chronic hepatitis C. 2) Response to treatment is the best predictive factor of the inhibition of fibrosis progression. 3) In non responders to the combination, it is not necessary to continue the ribavirin.