Current treatment options and response rates in children with chronic hepatitis C

Table 1 Sustained viral response in five representative prospective trials using polyethylene glycol-interferon alpha-2b and polyethylene glycol-interferon alpha-2a in combination with ribavirin and stratified for different clinical and laboratory parameters and genotypes, published between 2005 and 2011

	Wirth 20051	Jara 20081	Wirth 20101	Total PEG-interferon a-2b trials	Schwarz 20112	Sokal 20102	Total all trials
Dosage	1.5 μg/kg per week	1.0 μg/kg per week	60 μg/m² per week		180 μg/1.73 m²per week	100 μg/m² per week
Total (%)	36/61 (59)	15/30 (50)	70/107 (65.4)	121/198 (61.1)	29/55 (53)	43/65 (66.1)	193/318 (60.7)
Genotype (%)
1	22/46 (48)	12/26 (46)	38/72 (53)	72/144 (50)	21/45 (47)	27/47 (59)	120/236 (51)
2/3	13/13 (100)	3/3 (100)	28/30 (93)	44/46 (96)	8/10 (80)	16/17 (94)	68/73 (93)
4	1/2	0/1	4/5 (80)	5/8 (62)		Included in G1
ALT-levels (%)
Elevated	12/25 (48)		27/44 (61)			19/33 (58)	58/102 (57)
Normal	24/36 (67)		42/63 (67)			24/30 (80)	90/129 (70)
Mode of infection (%)
Parenteral	19/27 (70)	7/9 (78)	5/5 (100)	31/41(76)
Genotype 1	13/21 (62)		1/1
Vertical	12/25 (48)	8/21 (38)	46/75 (61)	66/121 (55)
Genotype 1	7/20 (35)		26/52 (50)	33/72 (46)
Break through	9.8%				6/41 (15)
Relapse	7.7%		8%		6/35 (17)

ALT: Alanine aminotransferase; PEG: Polyethylene glycol.

¹PEG-interferon α-2b;

²PEG-interferon α-2a.

Table 2 Most frequent adverse events during polyethylene glycol-interferon treatment in combination with ribavirin and its appraisal of clinical significance

Interferon α-treatment:

Leukopenia, thrombocytopenia: Frequent, not really significant; if necessary dose reduction

Flu-like symptoms: In all treated patients, not significant

Alopecia: Not significant

Autoimmune thyroiditis: At least 15 %, significant, mostly reversible

Acute psychosis, depression: Very seldom before puberty (< 1 %), rare in adolescents, significant in cases with manifestation; should be under investigation in future trials

Growth delay: Clinically not significant, catch-up growth, but under investigation with relative high priority

Anorexia, weight loss: Mostly not significant with exceptions, normalisation after therapy stop

Ribavirin:

Anemia: Mostly clinically not significant with exceptions, reversible

Most side effects’ intensity is decreasing after some weeks of treatment.

Table 3 Indication for hepatitis C virus treatment in children-pros and cons

In favour of treatment	Deferral might be considered
High response rate, sustained viral response means cure of the disease	Before 3-4 years of age because of possible spontaneous viral elimination
Prevention of disease progression and social burden	Psychiatric disorder
Better tolerability and less side effects in younger patients (particularly before puberty)	Low response rate in subjects with genotype 1 and high viral load
More favourable factors for response in children (e.g., low viral load)	Pubertal growth spurt
Parents facilitate compliance	More effective treatments in future in genotype 1 non-responders