Effect of peginterferon alfa-2a on liver histology in chronic hepatitis C:: A meta-analysis of individual patient data

被引:179
作者
Cammà, C
Di Bona, D
Schepis, F
Heathcote, EJ
Zeuzem, S
Pockros, PJ
Marcellin, P
Balart, L
Alberti, A
Craxì, A
机构
[1] CNR, IBIM, Palermo, Italy
[2] Univ Palermo, Cattedra Operat Gastroenterol, Palermo, Italy
[3] Univ Palermo, Unita Operat Gastroenterol, Palermo, Italy
[4] Univ Modena & Reggio Emilia, Dept Internal Med, Modena, Italy
[5] Toronto Western Hosp, Univ Hlth Network, Dept Med, Toronto, ON M5T 2S8, Canada
[6] Univ Frankfurt Klinikum, D-6000 Frankfurt, Germany
[7] Scripps Clin, La Jolla, CA USA
[8] Hop Beaujon, INSERM, U481, Serv Hepatol, Clichy, France
[9] Louisiana State Univ, Hlth Sci Ctr, New Orleans, LA USA
[10] Univ Padua, Dipartimento Med Clin & Sperimentale, Padua, Italy
关键词
D O I
10.1002/hep.20073
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Multicenter randomized trials have shown that once-weekly pegylated interferon (peginterferon) alfa-2a is more efficacious than conventional interferon alfa-2a (IFN) in patients with chronic hepatitis C. We performed a meta-analysis of 1,013 previously untreated patients (from 3 randomized trials) with pretreatment and post-treatment liver biopsies to assess the differences between peginterferon alfa-2a and IFN in terms of their effects on liver histology. Reported values were standardized mean differences (SMD) between patients receiving peginterferon alfa-2a and those receiving IFN (post-treatment value minus baseline value for each group). We used a random-effects model to quantify the average effect of peginterferon alfa-2a on liver histology. Peginterferon alfa-2a significantly reduced fibrosis compared with IFN (SMD, -0.14; 95% CI: -0.27, -0.01; P = .04). A reduction in fibrosis was observed among sustained virologic responders (SMD, -0.59; 95% CI: -0.89, -0-30; P < .0001) and patients with recurrent disease (SMD, -0.34; 95% CI: -0.54, -0.14; P = .0007), whereas no significant reduction was observed among nonresponders (SMD, -0.13; 95% CI: -0.32, 0.05; P = .15). Logistic regression analysis indicated that patients with sustained virologic responses (SVRs) had an odds ratio (OR) of 1.61 (95% CI: 1.14, 2.29) for reduction in fibrosis compared with patients without SVRs, whereas obese patients (body mass index [BMI] > 30 kg/m(2)) had an OR of 0.56 (95% CI: 0.35, 0.90) compared with normal-weight (BMI < 25 kg/m(2)) and overweight patients (BMI, 25-30 kg/M-2). In conclusion, in patients with chronic hepatitis C with or without cirrhosis, peginterferon alfa-2a (relative to IFN) significantly reduced fibrosis. The beneficial effects of peginterferon on liver histology are closely related to virologic response.
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页码:333 / 342
页数:10
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