Loading ...
Sorry, an error occurred while loading the content.

NATAP at AASLD

Expand Messages
  • claudine intexas
    NATAP www.natap.org ... AASLD Reported By Jules Levin Dallas October 27-31 2000 Response to Pegasys (Pegylated Interferon) by Blacks Mitchell Shiffman reported
    Message 1 of 1 , Oct 30, 2000
    • 0 Attachment
      NATAP
      www.natap.org
      ----------------

      AASLD
      Reported By Jules Levin
      Dallas October 27-31 2000

      Response to Pegasys (Pegylated Interferon) by Blacks

      Mitchell Shiffman reported results from an analysis of
      1208 patients
      from
      international randomized phase 1 & 2 studies in Blacks
      with chronic
      HCV.
      About 30% had cirrhosis and received either regular
      IFN or Pegylated
      IFN
      (Pegasys). There were 55 Blacks in this database.
      Remember no one
      received
      ribivarin, they only received IFN monotherapy.
      Response rates are
      better with
      combination therapy of IFN+RBV. Here is a preliminary
      report but I will
      follow this with more info so stay tuned. I have to
      rush to oral
      session.
      There are a number of presentations here on response
      to HCV therapy by
      Blacks, Hispanics & elderly which I'll report on
      later.

      After 72 weeks, 15% of Blacks taking PEG IFN (n=27)
      had sustained
      virologic
      response, versus 0% taking regular IFN (n=28). In
      Caucasians, after 72
      weeks
      34% had SVR taking PEG IFN (n=522) and 13% had SVR
      taking regular IFN
      (n=512).

      Also important is the histologic response. Blacks
      receiving PEG IFN had
      a 33%
      histologic response rate (n=15) compared to 61% in
      Caucasians (n=382).
      Nonetheless, Blacks did have a histologic response
      overall although it
      was
      less than that seen in Caucasians. For those receiving
      regular IFN 28%
      of
      Blacks (n=18) and 47% of Caucasians (n=331) had a
      histologic response.


      COMPARISON OF EPIDEMIOLOGICAL, CLINICAL, VIRAL AND
      LIVER HISTOLOGY IN
      AFRICAN-AMERICAN AND CAUCASIAN HEPATITIS C (HCV)
      PATIENTS.

      Gabriel Umeadi, Kester Crosse, Jacqueline Laurin,
      Frank A Anania, John
      C
      Papadimitriou, Cinthia I Drachenberg, Charles D
      Howell, Univ of
      Maryland,
      Baltimore, MD

      This study suggests HCV progression may not be as bas
      in Blacks as
      Whites,
      but it is a suggestion that needs to be studied.
      Perhaps, more
      importantly
      this study was small (56 Blacks) and was not conducted
      in coinfected
      individuals. HCV disease progression can be
      significantly worse & more
      severe
      when HIV is also present.

      Chronic hepatitis C (HCV) infection is 2 times more
      prevalent in
      African-Americans than White Americans. However,
      African-Americans are
      less
      likey to respond to interferon therapies, and a higher
      incidence of
      primary
      hepatocellular carcinoma and higher death rates due
      HCV. Paradoxically,
      others have reported that African-Americans as a group
      have a lower
      serum ALT
      levels, lower degrees of periportal piecemeal
      necrosis, and a slower
      rate of
      hepatic fibrosis. Goal: To compare the
      epidemiological, clinical,
      viral, and
      histological features of African-American and
      White-Americans who
      underwent
      liver biopsies for during evaluation for chronic HCV
      (anti-HCV+/serum
      HCV
      RNA+) at the University of MD between 1995 and 1998.
      Methods: The
      medical
      records of 56 African-Americans and 67 Non-Hispanic,
      White adult
      patients who
      were referred for HCV evaluation and who underwent a
      diagnostic liver
      biospy
      were reviewed. Patients referred for liver
      transplantation were
      excluded. The
      age, gender, mode of transmission, HCV genotype, HCV
      RNA, serum ALT,
      AST,
      alkaline phosphatase, total bilirubin, serum iron
      studies, and
      Histolgocial
      Activity Index (HAI) total, periportal hepatocyte
      necrosis,
      intralobular
      necrosis, portal inflammation, and fibrosis scores at
      the initial
      presentation were tabulated. Results were expressed as
      mean � SEM and
      compared by two-tailed, unpaired t-test (p < 0.05).

      Results: African-Americans were older (mean age 47.2 �
      0.8 vs. 43.5 �
      0.875;
      p = 0.003; Confidence Interval (CI): 1.25 - 6.12 ) and
      have shorter
      estimated
      duration of infection. In addition, African-Americans
      were more likely
      to be
      infected with HCV genotype 1 (91.6% vs. 67.8%). On the
      contrary,
      African-americans exhibited significantly lower serum
      ALT (83.4 � 6.6
      vs.
      120.1 � 10.9; p = 0.0065; CI: -63.1 - -10.5) and serum
      iron (103.6 �
      7..3 vs.
      132.1 � 9.5; p = 0.02; CI: -52 - -4.9) levels, and a
      trend toward lower
      degrees of periportal inflammation and hepatocyte
      necrosis (HAI I
      score: 2.2 �
      0.18 vs. 2.75 vs. 0.27; p = 0.10; CI: -1.2 - 0.124).
      African-Americans
      and
      White-Americans had similar modes of HCV transmission
      and frequency of
      alcohol abuse, serum AST, alkaline phosphatase,
      bilirubin, albumin,
      serum HCV
      RNA levels, total HAI score and similar degrees of
      intralobular
      necrosis,
      portal inflammation, and fibrosis. Only 3 subjects in
      each group had
      cirrhosis (NS).

      Conclusion: African- Americans were older at
      presentation and had a
      higher
      prevalence of HCV genotype 1 infection, but exhibit
      lower indices of
      liver
      inflammation hepatocyte damage than White patients.
      These results are
      similar
      to those reported previously by Wiley et al. (Gastro.
      118 (4pt. 1):
      A1012,
      2000), though the low incidence of cirrhosis precludes
      any inferences
      regarding the fibrosis rate. Theoretically, the lower
      iron burden and a
      tendency toward less periportal piecemeal necrosis
      inflammatory
      activity
      could decrease rates of hepatic fibrosis in
      African-Americans. However,
      longitudinal studies of well-defined cohorts will be
      necessary to
      determine
      whether the natural history of HCV is different in
      African-Americans.



      __________________________________________________
      Do You Yahoo!?
      Yahoo! Messenger - Talk while you surf! It's FREE.
      http://im.yahoo.com/
    Your message has been successfully submitted and would be delivered to recipients shortly.