Iron depletion is not effective in inducing a virologic response in patients with chronic hepatitis C who failed to respond to interferon therapy

OBJECTIVE: Some studies have suggested that increased iron stores may impac t negatively on the response to interferon in patients with chronic hepatit is C infection. We performed this prospective trial to determine the effect s of iron depletion on ALT and HCV-RNA levels in patients with chronic hepa titis C infection and to assess whether the response to interferon in patie nts who had previously failed to respond to interferon was enhanced by iron depletion. METHODS: Patients with chronic hepatitis C resistant to interferon therapy and no evidence of iron overload underwent weekly phlebotomies until the se rum ferritin level was below lower limits of normal for the subject's age a nd sex.. Patients were then started on interferon-alpha(2b), 3 million unit s subcutaneously three times per week for a period of 24 weeks. Iron studie s, ALT, and HCV-RNA levels were monitored at baseline, after phlebotomy and at 12 and 24 weeks of interferon therapy. RESULTS: Thirty-three patients were enrolled, 28 completed the study. A mea n of 7.2 units of blood were removed to achieve iron depletion. ALT levels decreased significantly with phlebotomy (142 IU/L before phlebotomy vs 82 I U/L after phlebotomy; p < 0.001), but log HCV-RNA levels remained unchanged (6.49 before phlebotomy vs 6.51 after phlebotomy). Interferon therapy did not improve ALT levels further. HCV-RNA levels were minimally reduced durin g interferon therapy (log HCV-RNA 6.49 before interferon vs 6.00 after 24 w eeks of interferon therapy). Two patients achieved a virologic end of treat ment response, both relapsed within 3 months after discontinuation of inter feron. No patient achieved a sustained virologic response. CONCLUSIONS: In patients who previously failed treatment with interferon, i ron depletion induced by phlebotomy improves ALT levels but is ineffective in achieving viral eradication in patients retreated with interferon 3 mill ion units three times per week. (Am J Gastroenterol 1999;94:3571-3575. (C) 1999 by Am. Coll. of Gastroenterology).