Interferón, ribavirina y amantadina en pacientes con hepatitis C crónica (genotipo 1) sin respuesta al tratamiento previo con interferón y ribavirina

Olveira, A.; Serrano, C.; Erdozain, J.C.; Calleja, J.L.; Castillo, P.; Segura, J.M.; Escartín, P.

doi:10.1016/S0210-5705(03)70395-1

Información del artículo

Resumen

Bibliografía

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Estadísticas

Objetivo

Pese a los progresos en el tratamiento de la hepatitis C crónica, en un elevado número de pacientes persiste la enfermedad tras el tratamiento con interferón y ribavirina, y se carece de otras opciones terapéuticas. Hemos investigado la eficacia de una triple terapia de retratamiento que incluye la amantadina.

Diseño experimental

Estudio piloto, prospectivo y abierto.

Pacientes y método

Se incluyó a 39 pacientes con hepatitis C crónica, genotipo 1, que no habían respondido previamente al tratamiento con interferón y ribavirina. Durante 48 semanas fueron tratados de nuevo con interferón alfa 2a (9 MU semanales), ribavirina (1.000-1.200 mg/día) y amantadina (200 mg/día).

Resultados

Cinco pacientes presentaban ARN-VHC indetectable en la semana 48 (12,8%) y tan sólo 2 tras 24 semanas de seguimiento (5,1% de respuestas sostenidas). En los que tenían una viremia basal < 8 × 105 U/ml las probabilidades de respuesta al final del tratamiento y respuesta sostenida fueron del 26,3 y el 10,5%, respectivamente; en los pacientes con elevadas viremias las respuestas fueron del 0%.

Conclusiones

En pacientes con hepatitis C crónica genotipo 1 no respondedores a interferón y ribavirina, el retratamiento con interferón, ribavirina y amantadina carece de utilidad.

Objective

Despite advances in the treatment of chronic hepatitis C virus (HCV), the disease persists after treatment with interferon and ribavirin in a large percentage of patients and other therapeutic options are lacking. We investigated the efficacy of retreatment with antiviral therapy including amantadine.

Experimental Design

prospective and open pilot study.

Patients

Thirty-nine patients with chronic HCV, genotype 1, who were nonresponders to interferon and ribavirin were included. The patients were given repeat treatment with interferon-alpha 2A (9 MU/week), ribavirin (1,000-1,200 mg/day) and amantadine (200 mg/day) for 48 weeks.

Results

HCV-RNA was undetectable in 5 patients in week 48 (12.8%) and in only 2 patients after 24 weeks of followup (5.1% of sustained responses). In patients with basal viremia of < 8 × 105 U/ml the probability of response at the end of treatment and of sustained response was 26.3 and 10.5%, respectively; in patients with elevated viremias response was 0%.

Conclusions

In patients with chronic HCV genotype 1 without response to interferon and ribavirin, triple antiviral therapy with interferon, ribavirin and amantadine is not useful.

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