AIM:To study current treatment options for pediatric hepatitis C infection and their associated success rates.METHODS:We retrospectively reviewed charts of thirty children who had been treated with combination therapy...AIM:To study current treatment options for pediatric hepatitis C infection and their associated success rates.METHODS:We retrospectively reviewed charts of thirty children who had been treated with combination therapy of pegylated interferon alfa plus ribavirin for chronic hepatitis C infection.Patients had been treated with ribavirin(15 mg/kg per day) and either pegylated interferon alfa 2a(180 mg/m 2 once weekly) or pegylated interferon alfa 2b(1.5 mg/kg once weekly).Patients' follow-up included subjective assessment of complaints,physical examination including weight and height,as well as laboratory evaluations for viral load [before treatment,at 12 wk,and 6 mo following treatment completion,as determined by sustained viral response(SVR)],complete blood count,liver enzymes,alkaline phosphatase,bilirubin,renal function tests,and thyroid function tests.For patients not achieving a two log decrease in viral load at treatment week 12,treatment was discontinued and the patient was considered a treatment non-responder.RESULTS:Thirty children aged 3-18 years were included in the study.Twenty patients(11 males,9 females) received pegylated interferon alfa 2b and ten patients(6 males,4 females) received pegylated interferon alfa 2a.Twenty-three patients were infected with genotype 1,six patients were infected with genotype 3,and one patient was infected with genotype 2.Twenty patients(67%) achieved SVR.Treatment success rates were 90% with pegylated interferon alfa 2a vs 55% with pegylated interferon alfa 2b.Although a trend was noted for improved outcomes in the group receiving pegylated interferon alfa 2a,there were no statistically significant outcome differences between the two treatment groups(P = 0.1).Treatment success was 56.5% for patients infected with genotype 1 virus,compared to 100% for patients infected with other genotypes(P = 0.064).There was no difference in treatment response between males and females.A cut-off age of twelve years was used to dichotomize younger vs older participants;however,no difference in treatment response was observed between these groups.Using multivariate regression analysis,we could not determine predictors for achieving SVR from among the variables we examined(age,sex,and viral genotype).Although we noted a trend toward SVR with peginterferon alfa-2a,there was no statistical difference between the two peginterferons.A high incidence of adverse reactions to treatment was noted.Twenty-five patients(83%) suffered from at least one adverse reaction,but most experienced more than one adverse reaction.All patients except one became leukopenic(white blood cell count less than 5500 leukocytes/μL),six(20%) became anemic(hemoglobin less than 110 g/L),and one(3.3%) became thrombocytopenic(platelets less than 100 000/μL).CONCLUSION:Combination therapy to treat hepatitisC in children is as effective as in adults.There may be a benefit for treatment with pegylated interferon alfa 2a.展开更多
文摘AIM:To study current treatment options for pediatric hepatitis C infection and their associated success rates.METHODS:We retrospectively reviewed charts of thirty children who had been treated with combination therapy of pegylated interferon alfa plus ribavirin for chronic hepatitis C infection.Patients had been treated with ribavirin(15 mg/kg per day) and either pegylated interferon alfa 2a(180 mg/m 2 once weekly) or pegylated interferon alfa 2b(1.5 mg/kg once weekly).Patients' follow-up included subjective assessment of complaints,physical examination including weight and height,as well as laboratory evaluations for viral load [before treatment,at 12 wk,and 6 mo following treatment completion,as determined by sustained viral response(SVR)],complete blood count,liver enzymes,alkaline phosphatase,bilirubin,renal function tests,and thyroid function tests.For patients not achieving a two log decrease in viral load at treatment week 12,treatment was discontinued and the patient was considered a treatment non-responder.RESULTS:Thirty children aged 3-18 years were included in the study.Twenty patients(11 males,9 females) received pegylated interferon alfa 2b and ten patients(6 males,4 females) received pegylated interferon alfa 2a.Twenty-three patients were infected with genotype 1,six patients were infected with genotype 3,and one patient was infected with genotype 2.Twenty patients(67%) achieved SVR.Treatment success rates were 90% with pegylated interferon alfa 2a vs 55% with pegylated interferon alfa 2b.Although a trend was noted for improved outcomes in the group receiving pegylated interferon alfa 2a,there were no statistically significant outcome differences between the two treatment groups(P = 0.1).Treatment success was 56.5% for patients infected with genotype 1 virus,compared to 100% for patients infected with other genotypes(P = 0.064).There was no difference in treatment response between males and females.A cut-off age of twelve years was used to dichotomize younger vs older participants;however,no difference in treatment response was observed between these groups.Using multivariate regression analysis,we could not determine predictors for achieving SVR from among the variables we examined(age,sex,and viral genotype).Although we noted a trend toward SVR with peginterferon alfa-2a,there was no statistical difference between the two peginterferons.A high incidence of adverse reactions to treatment was noted.Twenty-five patients(83%) suffered from at least one adverse reaction,but most experienced more than one adverse reaction.All patients except one became leukopenic(white blood cell count less than 5500 leukocytes/μL),six(20%) became anemic(hemoglobin less than 110 g/L),and one(3.3%) became thrombocytopenic(platelets less than 100 000/μL).CONCLUSION:Combination therapy to treat hepatitisC in children is as effective as in adults.There may be a benefit for treatment with pegylated interferon alfa 2a.
