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Am J Kidney Dis. 2008 Feb;51(2):263-77. doi: 10.1053/j.ajkd.2007.11.003.

Interferon treatment in hemodialysis patients with chronic hepatitis C virus infection: a systematic review of the literature and meta-analysis of treatment efficacy and harms.

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  • 1Division of Nephrology, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, MA 02111, USA.

Abstract

BACKGROUND:

Hepatitis C virus (HCV) infection is prevalent in patients undergoing hemodialysis and is associated with greater mortality. We determined the efficacy and harms of interferon (IFN) and pegylated IFN (PEG-IFN) treatment of hemodialysis patients with chronic HCV infection and identified factors associated with these outcomes.

STUDY DESIGN:

Meta-analysis and meta-regression of randomized controlled trials, uncontrolled trials, and prospective observational studies.

SETTING & POPULATION:

Hemodialysis patients with chronic HCV infection.

SELECTION CRITERIA FOR STUDIES:

MEDLINE indexed studies since 1966, sample size greater than 10.

INTERVENTION:

IFN-based treatment, including PEG-IFN with and without ribavirin.

OUTCOMES:

Sustained virological response (SVR) 6 months after treatment, rate of treatment discontinuation caused by adverse events, and factors associated with these outcomes.

RESULTS:

20 studies of 459 IFN-treated patients, 3 studies of 38 PEG-IFN-treated patients, and 2 studies of 49 PEG-IFN and ribavirin-treated patients met inclusion criteria. The overall SVR rate was 41% (95% confidence interval [CI], 33 to 49) for IFN and 37% (95% CI, 9 to 77) for PEG-IFN. Treatment discontinuation rates were 26% (95% CI, 20 to 34) for IFN and 28% (95% CI, 12 to 53) for PEG-IFN. SVR was higher with 3 million units (MU) or higher of IFN 3 times weekly, with lower mean HCV RNA, and with lower rates of cirrhosis, HCV genotype 1 or elevated transaminase, but these findings were not statistically significant. Treatment discontinuation rates were greater in studies using larger doses.

LIMITATIONS:

Publication bias, few randomized controlled trials, and limitations in generalizability to all hemodialysis patients.

CONCLUSION:

IFN treatment of hemodialysis patients results in an SVR rate of 41%. Higher dose, lower mean HCV RNA level, and lower rates of cirrhosis, transaminase level increase, and HCV genotype 1 may be associated with greater SVR rates, but additional studies using individual patient data are needed.

PMID:
18215704
[PubMed - indexed for MEDLINE]
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