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
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
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.