The Efficacy Of Antiviral Therapy With Low Dose Peg-interferon α-2a Plus Ribavirin In Patients With Decompensated HCV-related Cirrhosis

Objective:To investigate the efficacy,safety and tolerance of antiviral therapy with low dose Peg-interferon a-2a plus ribavirin in patients with decompensated HCV-related cirrhosis.Methods:119 decompensated HCV-related cirrhotic patients in digestive department of China-Japan union hospital from January 2004 to March 2009 were included. All the patients were diagnosed according to the hepatitis C prevention and treatment guidelines in the year 2004, and according to imaging, biochemistry and/or pathological index, and HCV RNA were above 1.0×103 copies/ml. Gastrointestinal bleeding, hepatic encephalopathy, primary liver cancer and other complications were excluded, and liver function Child-Pugh level were B/C. For patients with hypersplenism(neutrophils<1.0×109/L and/or platelet<50×109/ L), treated with partial splenic embolization before antiviral therapy. For all the patients who meets the therapy criterion of interferon, treated with Peg-interferonα-2a 180μg/w plus ribavirin 800～1200mg/d, a treatment of 48 weeks and a follow-up of 24 weeks were planned in all the patients. During the course of treatment, adjust the dosage of Peg-interferonα-2a and ribavirin according to tolerance. For those who received a low dose of Peg-interferonα-2a, the duration would be prolonged to 72 weeks, and follow up for 24 weeks. The remaining 66 patients not receiving antiviral therapy as control were followed up to 96 weeks.Results:To analyze the HCV genotype of 53 patients who will receive antiviral therapy, type 2b (17 patients,32.08%) dominated, la-type (14 patients,26.42%) second, followed by lb-type (10 patients,18.87%),2a-type (9 patients,16.98%) and not separating the type (3 patients, 5.66%). To evaluate the liver function before antiviral therapy, the results showed that 38 cases(71.70%) were classified Child-Pugh B,15 cases(28.3%) were classified Child-Pugh C. After PSE,24 of 26 patients with hypersplenism(neutrophils<1.0×109/L and/or platelet <50×109/L) achieved the criterion of interferon therapy. All the 51 patients were given antiviral treatment. The results showed that Peg-interferonα-2a dose was adjusted in 48 patients, the ribavirin dose were adjusted in 37 patients.5 patients stopped treatment at 29 weeks,40 weeks,48 weeks,50 weeks and 55 weeks respectively. The remaining 43 patients completed 72 weeks of treatment. After completing the treatment, to analyze the relationgship between Peg-interferonα-2a and ribavirin cumulative explosure dose and the sustained virological response, the results showed that with the drug cumulative explosure dose increased, the SVR rate increased, and the relapse rate decreased. To analyze the Child-Pugh score changes in the decompensated HCV-related cirrhosis after 24 weeks follow-up, the results showed Child-Pugh score decreased significantly in the treatment group, P value<0.05, while it increased in the untreated control group at week 96, P value<0.05. Patients of treatment group were followed up to 24 weeks after the end of treatment, and the control group were followed up to 24 weeks,to analyze the disease progression, the results showed that the disease progression in the treatment group was 15.69%, significantly lower than the untreated control group(31.82%), P value<0.05. To further analyze the relationship between virological response and disease progression, the results showed that the disease progression rate in patients who achieved SVR was lower than it in those who didn't. In the course of treatment, all patients had varying degrees of cytopenia, and 45 patients (88.24%) of fatigue and muscle pain,40 patients (78.43%) fever. There were still some loss of appetite, hair loss, abnormal blood glucose, rash, hypothyroidism, etc., after symptomatic treatment, they can be alleviated. No patient died in the antiviral treatment.Conclusions:In the 53 patients who would receive antiviral therapy, type 2b (32.08%) dominated, 1a-type (26.42%) second, followed by 1b-type (18.87%),2a-type (16.98%) and not separating the type (5.66%). PSE can improve the situation of reduced blood cells in hypersplenism patients, which provide conditions for the interferon treatment. The application of low dose Peg-IFNα-2a plus ribavirin for decompensated HCV-related cirrhotic patients in antiviral therapy, with the drug cumulative explosure dose increased, the SVR rate increased, and the relapse rate decreased. Low dose of Peg-IFNα-2a plus ribavirin antiviral therapy for decompensated HCV-related cirrhotic patients, can improve the Child-Pugh score of patients, slow disease progression. Common side effects were fatigue, muscle pain, fever, hemolytic anemia and bone marrow suppression.5 patients discontinued because of bone marrow suppression, no patient died during the antiviral therapy.