Iron reduction and sustained response to interferon-α therapy in patients with chronic hepatitis C: Results of an Italian multicenter randomized study

Silvia Fargion, Anna Ludovica Fracanzani, Angelo Rossini, Mauro Borzio, Oliviero Riggio, Giovanni Belloni, Franco Bissoli, Roberto Ceriani, Marco Ballarè, Marco Massari, Caterina Trischitta, Pierluigi Fiore, Anna Orlandi, Lorenzo Morini, Michela Mattioli, Silvia Oldani, Bruno Cesana, Gemino Fiorelli

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: It has been suggested that iron depletion improves the response to interferon in patients with chronic hepatitis C. We aimed to evaluate whether iron reduction by phlebotomy before interferon improves the rate of virological sustained response in previously untreated noncirrhotic patients. METHODS: One hundred fourteen hepatitis C virus (HCV) RNA positive patients with hepatic iron concentrations of ≥700 μg/g dry wt (men) and ≥500 μg/g dry wt (women), stratified according to HCV genotype and γ-glutamyltransferase values, were randomly allocated to interferon alone (6 MU three times a week) (group A) or to phlebotomy until iron depletion followed by interferon (6 MU three times a week) (group B). After 4 months dosage was reduced to 3 MU three times a week for another 8 months. RESULTS: Virological sustained response was observed in 25 patients (22%), nine (15.8%, 95% CI = 7.5-27.9) of group A and 16 (28.1%, 95% CI = 17.0-41.6) of group B. At univariate analysis the variables associated with the response were HCV genotypes 2-3, normal γ-glutamyltransferase, higher levels of baseline ALT, normal ALT values, and negativity for HCV-RNA at the 3rd month of therapy. At multivariate analysis, genotype and ALT levels at enrollment maintained their association with the response. A trend toward a better response to interferon was observed in patients who received phlebotomy (odds ratio = 2.32, 95% CI = 0.96-6.24, p = 0.082). Patients with hepatic iron concentration of ≤1100 μg/g dry wt had a trend toward a higher rate of virological sustained response (p = 0.059) when submitted to treatment B. CONCLUSION: Iron removal by phlebotomy is able to improve the rate of response to interferon, especially in patients with lower hepatic iron deposits; it could be useful as adjuvant therapy to new therapeutic modalities.

Original languageEnglish
Pages (from-to)1204-1210
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume97
Issue number5
DOIs
Publication statusPublished - 2002

ASJC Scopus subject areas

  • Gastroenterology

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