Antiviral treatment and liver-related complications in hepatitis delta - PubMed (original) (raw)

Comparative Study

. 2017 Feb;65(2):414-425.

doi: 10.1002/hep.28876. Epub 2016 Nov 30.

Beatriz Calle Serrano 1, Benjamin Heidrich 1 2, Janina Kirschner 1, Birgit Bremer 1, Patrick Lehmann 1, Svenja Hardtke 1 2, Katja Deterding 1, Kerstin Port 1, Max Westphal 3, Michael P Manns 1 2 4, Markus Cornberg 1 2, Heiner Wedemeyer 1 2 4

Affiliations

Comparative Study

Anika Wranke et al. Hepatology. 2017 Feb.

Abstract

Hepatitis delta virus (HDV) is the most severe form of viral hepatitis. Pegylated interferon alfa (PEG-IFNα) is effective in only 25%-30% of patients and is associated with frequent side effects. The aim of this study was to analyze the clinical long-term outcome of hepatitis delta in relation to different antiviral treatment strategies. We studied 136 anti-HDV-positive patients who were followed for at least 6 months in a retrospective single-center cohort (mean time of follow-up, 5.2 years; range, 0.6-18.8). Liver cirrhosis was already present in 62 patients at first presentation. Twenty-nine percent of patients did not receive any antiviral treatment, 38% were treated with interferon alfa (IFNα)-based therapies, and 33% received nucleos(t)ide analogues (NAs) only. Clinical endpoints defined as hepatic decompensation (ascites, encephalopathy, and variceal bleeding), hepatocellular carcinoma, liver transplantation, and liver-related death developed in 55 patients (40%). Patients who received IFNα-based therapies developed clinical endpoints less frequently than those treated with NA (P = 0.02; HR, 4.0) or untreated patients (P = 0.05; HR, 2.2; 17%, 64%, and 44%), respectively, which was significant in both chi-square and Kaplan-Meier analysis. In addition, considering various clinical and virological parameters, IFNα therapy was independently associated with a more benign clinical long-term outcome in multivariate logistic regression analysis (P = 0.04; odds ratio, 0.25; 95% confidence interval, 0.07-0.9). Loss of HDV RNA during follow-up was more frequent in IFNα-treated patients and strongly linked with a lower likelihood to experience liver-related complications.

Conclusion: IFNα-based antiviral therapy of hepatitis delta was independently associated with a lower likelihood for clinical disease progression. Durable undetectability of HDV RNA is a valid surrogate endpoint in the treatment of hepatitis delta. (Hepatology 2017;65:414-425).

© 2016 by the American Association for the Study of Liver Diseases.

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