Alavian Seyed Moayed, Tabatabaei Seyed Vahid
Research Center for Gastroenterology and Liver Disease, Baqiyatollah University of Medical Sciences, Tehran, Iran.
Iran J Kidney Dis. 2010 Jul;4(3):181-94.
The efficacy and safety of pegylated and standard interferon (IFN) have been scrutinized in meta-analyses; however, factors associated with hepatitis C viral response in patients on hemodialysis are not well investigated.
We evaluated factors that could be associated with sustained virological response (SVR) to pegylated or standard IFN monotherapy in patients on hemodialysis with chronic hepatitis C virus (HCV) infection, by performing a systematic review of the literature with a meta-analysis of clinical trials. We used both Mantel-Haenszel and DerSimonian and Laird random effects models, with heterogeneity and sensitivity analyses.
Twenty-one studies on IFN-alfa2a or IFN-alfa2b (491 patients) and 12 on pegylated-IFN-alfa2a or PEG-IFN-alfa2b (279 patients) were evaluated. The pooled SVR for standard and pegylated IFN monotherapy in random effects model was 39.1% (95% confidence interval [CI], 32.1 to 46.1) and 39.3% (95% CI, 26.5 to 52.1), respectively. Pooled dropout rates were 22.6% (95% CI, 10.4 to 34.8) and 29.7% (95% CI, 21.7 to 37.7), respectively. Female gender, HCV-RNA copies per milliliter, HCV genotype, alanine transaminase pattern, duration of infection, liver fibrosis stage, and treatment duration were not associated with SVR. Only an age less than 40 years was significantly associated with SVR in both models (odds ratio, 2.17; 95% CI, 1.03 to 4.50).
Additional benefit of monotherapy with pegylated IFN in patients on hemodialysis with HCV infection in terms of viral response and adverse events is still unclear. According the current literature, younger age was the only determinant of SVR.
聚乙二醇化干扰素和标准干扰素（IFN）的疗效和安全性已在荟萃分析中得到详细审查；然而，血液透析患者丙型肝炎病毒反应相关因素尚未得到充分研究。
我们通过对文献进行系统回顾并对临床试验进行荟萃分析，评估了慢性丙型肝炎病毒（HCV）感染的血液透析患者对聚乙二醇化或标准干扰素单药治疗持续病毒学应答（SVR）可能相关的因素。我们使用了曼特尔 - 亨塞尔法以及德西蒙尼安和莱尔德随机效应模型，并进行了异质性和敏感性分析。
评估了21项关于干扰素 - α2a或干扰素 - α2b的研究（491例患者）以及12项关于聚乙二醇化干扰素 - α2a或聚乙二醇化干扰素 - α2b的研究（279例患者）。随机效应模型中标准干扰素和聚乙二醇化干扰素单药治疗的汇总SVR分别为39.1%（95%置信区间[CI]，32.1至46.1）和39.3%（95%CI，26.5至52.1）。汇总的退出率分别为22.6%（95%CI，10.4至34.8）和29.7%（95%CI，21.7至37.7）。女性性别、每毫升HCV - RNA拷贝数、HCV基因型、丙氨酸转氨酶模式、感染持续时间、肝纤维化阶段和治疗持续时间与SVR无关。在两个模型中，仅年龄小于40岁与SVR显著相关（优势比，2.17；95%CI，1.03至4.50）。
对于HCV感染的血液透析患者，聚乙二醇化干扰素单药治疗在病毒反应和不良事件方面的额外益处仍不明确。根据当前文献，年龄较小是SVR的唯一决定因素。
