Chronic hepatitis C infection [CHCV] is a major cause of morbidity and mortality. It is treated with a combination of interferon and ribavirin [INF/RIBV] for 1 year in strain 1 & 4 prevalent in our geographic area 1. Iron overload is an important cofactor of disease outcome, enhancing inflammation, fibrosis and cirrhosis and predisposing to hepatocellular carcinoma. It also affects the response to conventional therapy2–,3. We evaluated the impact of pre-treatment iron chelation using deferasirox on the outcome of combination therapy (160μg PEG-Interferon α-2-a (Reiferon-Retard) and ribavirin) in terms of early viral response defined as clearance or 2 log reduction in viral load at 12 weeks and rapid viral response defined as viral clearance by four weeks. The latter may imply a shortened duration of therapy to 6 months rather than a year, improving cost effectiveness and reducing side effects 4,5. The study included 30 patients with CHCV candidates for INF/RIBV therapy with a Metavir score of less than F3 by liver biopsy or fibrotest. The mean serum ferritin of patients prior to therapy was 520+/−98 ng/ml. Ten patients were subjected to iron chelation using deferasirox (15mg/Kg/day p.o.) for 6–8 weeks prior initiation of therapy (group I), bringing their serum ferritin to 309+/−74 ng/ml, whereas 20 patients started therapy without pre-treatment chelation (group II). Patients were followed up periodically both clinically and laboratory. HCV PCR both quantitative and qualitative were conducted at week 4 and 12. In 7 patients (70%) from group I, early viral clearance at 12 weeks, was reported compared to 12 (60%) in group II (p>0.05). Six patients out of the 7 cleared in group I and 6 patients out of the 12 in group II (p<0.01) had a rapid virologic response with complete viral clearance at 4 weeks. Pre-treatment with deferasirox may improve early viral response rates. It seems to favor rapid virologic response in CHCV patients treated with INF/RIBV with a potential shorter duration of therapy, significant cost reduction and less side effects. Larger studies are needed to confirm the results of this pilot work.

Topics:
deferasirox, hepatitis c, chronic, human leukocyte interferon, infections, interferons, ribavirin, adverse effects, duration of treatment, iron chelation therapy, serum ferritin level result
1
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Brown RS Jr.,
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Payan C et al.,
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Author notes

Disclosure:Off Label Use: Use of deferasirox in iron overload resulting from chronic hepatitis C infection.

2007, The American Society of Hematology
2007
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