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Peg-IFN and ribavir...
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Ackefors, M.Karolinska University Hospital
(författare)
Peg-IFN and ribavirin treatment for recurrence of genotype 2 and 3 hepatitis C after liver transplantation
- Artikel/kapitelEngelska2015
Förlag, utgivningsår, omfång ...
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2015-02-04
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Informa UK Limited,2015
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LIBRIS-ID:oai:gup.ub.gu.se/218197
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https://gup.ub.gu.se/publication/218197URI
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https://doi.org/10.3109/00365548.2014.984322DOI
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https://lup.lub.lu.se/record/7422898URI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:131274849URI
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Background: Relapse of hepatitis C virus (HCV) infection after liver transplantation (LT) is universal. Tolerance for treatment with pegylated-interferon (peg-IFN) and ribavirin (RBV) is suboptimal and withdrawals due to adverse events frequent. We sought to improve tolerance for treatment to improve outcome. Methods: We used concentration-guided RBV dosing to achieve an intended 10 mu mol/L concentration with darbepoetin support in combination with peg-IFN alfa-2a, 180 mu g for genotype 1 and 135 mu g for genotype 2/3 to improve tolerance. Results: A total of 51/54 patients (94%) completed a full treatment course. In the per-protocol analysis 43% of patients (22/51) achieved sustained virological response (SVR), 82% with HCV genotype 2/3 and 22% with genotype 1, p = 0.0001. Patients with IL28B CC achieved SVR in 73% (8/11) and patients with non-CC in 33% (14/43), p = 0.016. Patients with mild fi brosis (fi brosis stage 1-2) achieved SVR in 56% (15/27), and patients with advanced fi brosis (fi brosis stage 3 -4) in only 26% (7/27), p = 0.0267. Conclusions: Concentration-guided RBV dosing with darbepoetin support substantially improves tolerance and offers high adherence to a full peg-IFN and RBV treatment course in patients with post-transplant HCV relapse. With this approach genotype 2 and 3 infections can be treated cost-effectively post-transplant. Genotype 1, IL28B non-CC genotype, and advanced fi brosis predicted a low SVR rate.
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Biuppslag (personer, institutioner, konferenser, titlar ...)
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Castedal, Maria,1964University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för kirurgi,Institute of Clinical Sciences, Department of Surgery(Swepub:gu)xcasma
(författare)
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Dahlgard, O.Oslo university hospital
(författare)
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Verbaan, HansLund University,Lunds universitet,Gastroenterologi,Forskargrupper vid Lunds universitet,Gastroenterology,Lund University Research Groups(Swepub:lu)medf-hve
(författare)
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Gjertsen, H.Karolinska Institutet
(författare)
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Wernerson, A.Karolinska Institutet
(författare)
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Weiland, O.Karolinska Institutet
(författare)
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Karolinska University HospitalInstitutionen för kliniska vetenskaper, Avdelningen för kirurgi
(creator_code:org_t)
Sammanhörande titlar
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Ingår i:Scandinavian Journal of Infectious Diseases: Informa UK Limited47:4, s. 209-2170036-55481651-1980
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Ingår i:Infectious Diseases: Informa UK Limited47:4, s. 209-2172374-42352374-4243
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