Wiegand Johannes, Buggisch Peter, Boecher Wulf, Zeuzem Stefan, Gelbmann Cornelia M, Berg Thomas, Kauffmann Wolfgang, Kallinowski Birgit, Cornberg Markus, Jaeckel Elmar, Wedemeyer Heiner, Manns Michael P
Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.
Hepatology. 2006 Feb;43(2):250-6. doi: 10.1002/hep.21043.
Early treatment of acute hepatitis C with interferon alpha-2b for 24 weeks prevents chronic infection in almost all patients. Because pegylated interferons have replaced conventional interferon in the therapy of chronic hepatitis C, the aim of this study was to analyze the efficacy of an early treatment of acute hepatitis C with peginterferon alpha-2b. Between February 2001 and February 2004, 89 individuals with acute HCV infection were recruited at 53 different centers in Germany. Patients received 1.5 microg/kg peginterferon alpha-2b for 24 weeks; treatment was initiated after a median of 76 days after infection (range 14-150). End-of-treatment response and sustained virological response were defined as undetectable HCV RNA at the end of therapy and after 24 weeks of follow-up, respectively. In the total study population, virological response was 82% at the end of treatment and 71% at the end of follow-up. Of 89 individuals, 65 (73%) were adherent to therapy, receiving 80% of the interferon dosage within 80% of the scheduled treatment duration. End-of-treatment and sustained virological response rates in this subpopulation were 94% and 89%, respectively. A maximum alanine aminotransferase level of more than 500 U/L prior to therapy was the only factor associated with successful treatment. In conclusion, in acute HCV infection, early treatment with peginterferon alpha-2b leads to high virological response rates in individuals who are adherent to treatment. The high number of dropouts underlines the importance of thorough patient selection and close monitoring during therapy. Thus, future studies should identify factors predicting spontaneous viral clearance to avoid unnecessary therapy.
用α-2b干扰素对急性丙型肝炎进行24周的早期治疗可防止几乎所有患者发生慢性感染。由于聚乙二醇化干扰素已在慢性丙型肝炎治疗中取代了传统干扰素，本研究的目的是分析用聚乙二醇化α-2b干扰素对急性丙型肝炎进行早期治疗的疗效。在2001年2月至2004年2月期间，德国53个不同中心招募了89例急性HCV感染患者。患者接受1.5μg/kg聚乙二醇化α-2b干扰素治疗24周；治疗在感染后中位76天（范围14 - 150天）开始。治疗结束时的反应和持续病毒学反应分别定义为治疗结束时和随访24周后HCV RNA检测不到。在整个研究人群中，治疗结束时病毒学反应率为82%，随访结束时为71%。89例患者中，65例（73%）坚持治疗，在预定治疗时间的80%内接受了80%的干扰素剂量。该亚组治疗结束时和持续病毒学反应率分别为94%和89%。治疗前最大丙氨酸氨基转移酶水平超过500 U/L是与治疗成功相关的唯一因素。总之，在急性HCV感染中，用聚乙二醇化α-2b干扰素进行早期治疗可使坚持治疗的个体获得较高的病毒学反应率。大量患者退出强调了在治疗期间进行彻底的患者选择和密切监测的重要性。因此，未来的研究应确定预测病毒自发清除的因素，以避免不必要的治疗。
