Effect of peginterferon alfa‐2a on liver histology in chronic hepatitis C: A meta‐analysis of individual patient data

• Published in: Hepatology (Baltimore, Md.) Vol. 39; no. 2; pp. 333 - 342
• Main Authors: Cammà, Calogero, Di Bona, Danilo, Schepis, Filippo, Heathcote, E. Jenny, Zeuzem, Stefan, Pockros, Paul J., Marcellin, Patrick, Balart, Luis, Alberti, Alfredo, Craxì, Antonio
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.02.2004; Wiley
• Subjects: Adult; Antiviral Agents - therapeutic use; Biological and medical sciences; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - pathology; Human viral diseases; Humans; Infectious diseases; Interferon-alpha - therapeutic use; Liver - pathology; Liver - virology; Liver Cirrhosis - pathology; Liver Cirrhosis - virology; Male; Medical sciences; Middle Aged; Polyethylene Glycols; Predictive Value of Tests; Recombinant Proteins; Treatment Outcome; Viral diseases; Viral hepatitis; Human; Data analysis; Hepatic disease; Histology; Infection; Viral hepatitis A; Chronic; Peginterferon alfa-2a; Viral disease; Individual; Gastroenterology; Digestive diseases; Viral hepatitis C
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.20073

Multicenter randomized trials have shown that once‐weekly pegylated interferon (peginterferon) alfa‐2a is more efficacious than conventional interferon alfa‐2a (IFN) in patients with chronic hepatitis C. We performed a meta‐analysis of 1,013 previously untreated patients (from 3 randomized trials) with pretreatment and post‐treatment liver biopsies to assess the differences between peginterferon alfa‐2a and IFN in terms of their effects on liver histology. Reported values were standardized mean differences (SMD) between patients receiving peginterferon alfa‐2a and those receiving IFN (post‐treatment value minus baseline value for each group). We used a random‐effects model to quantify the average effect of peginterferon alfa‐2a on liver histology. Peginterferon alfa‐2a significantly reduced fibrosis compared with IFN (SMD, −0.14; 95% CI: −0.27, −0.01; P = .04). A reduction in fibrosis was observed among sustained virologic responders (SMD, −0.59; 95% CI: −0.89, −0.30; P < .0001) and patients with recurrent disease (SMD, −0.34; 95% CI: −0.54, −0.14; P = .0007), whereas no significant reduction was observed among nonresponders (SMD, −0.13; 95% CI: −0.32, 0.05; P = .15). Logistic regression analysis indicated that patients with sustained virologic responses (SVRs) had an odds ratio (OR) of 1.61 (95% CI: 1.14, 2.29) for reduction in fibrosis compared with patients without SVRs, whereas obese patients (body mass index [BMI] > 30 kg/m2) had an OR of 0.56 (95% CI: 0.35, 0.90) compared with normal‐weight (BMI < 25 kg/m2) and overweight patients (BMI, 25–30 kg/m2). In conclusion, in patients with chronic hepatitis C with or without cirrhosis, peginterferon alfa‐2a (relative to IFN) significantly reduced fibrosis. The beneficial effects of peginterferon on liver histology are closely related to virologic response. (HEPATOLOGY 2004;39:333–342.)