RISKS AND BENEFITS OF INTERFERON-ALPHA IN THE TREATMENT OF HEPATITIS

Citation
M. Pardo et al., RISKS AND BENEFITS OF INTERFERON-ALPHA IN THE TREATMENT OF HEPATITIS, Drug safety, 13(5), 1995, pp. 304-316
Citations number
NO
Categorie Soggetti
Toxicology,"Pharmacology & Pharmacy","Public, Environmental & Occupation Heath
Journal title
ISSN journal
01145916
Volume
13
Issue
5
Year of publication
1995
Pages
304 - 316
Database
ISI
SICI code
0114-5916(1995)13:5<304:RABOII>2.0.ZU;2-U
Abstract
The high worldwide prevalence of chronic viral hepatitis, as well as i ts progressive course, have led to the performance of multiple clinica l studies, The natural history of the disease is different depending o n the infecting virus; thus, the evolution to liver cirrhosis and/or h epatocellular carcinoma for the hepatitis B, C and delta (D) viruses i n chronic hepatitis is 15, 20 and 75%, respectively, Different therape utic agents have been used in attempts to modify the natural course of these diseases, interferon-alpha (IFN alpha) having proved to be the most effective. In 30 to 50% of patients, treatment with IFN alpha has achieved inhibition of viral replication, as well as normalisation of aminotransferase levels. Moreover, in a majority of patients, histolo gical improvement is observed, principally in piecemeal necrosis and p ortal inflammation. The dosage currently recommended for treatment of chronic hepatitis B is 30 to 35MU weekly for a minimum of 4 months; wh en there is a co-existing delta virus infection, the total dosage empl oyed should be greater. For hepatitis C, the minimum effective dosage is 9MU weekly, and a treatment duration of 12 months is recommended. T he administration of IFN alpha produces a series of dose-dependent adv erse effects, which are reversible on suspension of the medication. Th e most frequent of these adverse reactions is the 'flu-like' syndrome, which is self-limited and generally well tolerated. Secondary haemato logical alterations (leucopenia and thrombocytopenia) are the most fre quent cause of reduction in dosage or suspension of treatment, althoug h the latter is not normally necessary. The proportion of patients req uiring dosage modification or suspension of treatment fluctuates betwe en 5 and 15%. Taking the evolution of chronic hepatitis into account, there can be no doubt that all patients with this disease should be of fered treatment. At present, the drug of choice is IFN alpha, as it sl ows disease progression and it is generally well tolerated.