Brief Article
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World J Gastroenterol. Feb 21, 2013; 19(7): 1098-1103
Published online Feb 21, 2013. doi: 10.3748/wjg.v19.i7.1098
Pegylated interferon alfa and ribavirin for children with chronic hepatitis C
Irit Rosen, Michal Kori, Orly Eshach Adiv, Baruch Yerushalmi, Nataly Zion, Ron Shaoul
Irit Rosen, Orly Eshach Adiv, Nataly Zion, Ron Shaoul, Pediatric Gastroenterology and Nutrition Unit, Meyer Children’s Hospital, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Haifa 31096, Israel
Michal Kori, Pediatric Gastroenterology and Nutrition Unit, Kaplan Medical Center, Rehovot 76100, Israel
Baruch Yerushalmi, Pediatric Gastroenterology and Nutrition Unit, Soroka Medical Center, Ben Gurion University Faculty of Medicine, Be’er Sheva 84101, Israel
Author contributions: Shaoul R initiated the study; Rosen I and Shaoul R wrote the manuscript; Rosen I, Shaoul R, Eshach Adiv O, Kori M, Zion N, and Yerushalmi B collected patients’ data and performed follow-up.
Correspondence to: Irit Rosen, MD, Pediatric Gastroenterology and Nutrition Unit, Meyer Children’s Hospital, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, Technion, PO Box 9697, Efron Street Bat-Galim, Haifa 31096, Israel. irita111@gmail.com
Telephone: +972-4-8542914 Fax: +972-4-8541805
Received: June 14, 2012
Revised: September 4, 2012
Accepted: October 16, 2012
Published online: February 21, 2013
Abstract

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/m2 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 hepatitis C in children is as effective as in adults. There may be a benefit for treatment with pegylated interferon alfa 2a.

Keywords: Hepatitis C virus; Interferon alfa; Ribavirin; Children; Sustained viral response