Reactivation of sarcoidosis during interferon therapy.

The exacerbation of a co-existing autoimmune disease is often a concern for physicians who use immunomodulating agents for the treatment of a concomitant process. As physicians begin to treat chronic hepatitis C more often and more aggressively, this potential problem with occur more frequently. Herein we reported a case of reactivation of sarcoidosis occurring during the treatment of chronic hepatitis C, and we present a literature review of other centers' experiences with this problem. Depending upon the severity of the exacerbation and the type of organ involvement, reactivation of sarcoidosis may require discontinuation of the interferon therapy, with or without the use of additional steroids. The majority of patients, however, do not require the use of steroids. Interestingly, continuation of the interferon therapy in the presence of a mild-to-moderate exacerbation of sarcoidosis may be safe in a minority of patients with noncritical organ involvement.

Daily interferon therapy for chronic hepatitis C: a report of a community practice experience.

BACKGROUND/AIMS: Chronic hepatitis C is widely prevalent and is the commonest indication for liver transplantation in the United States. Standard treatment with interferon-alpha at 3 million units (MU) three times a week for 6-12 months has yielded poor results. The addition of ribavirin has not significantly increased response rates, and at the same time has been associated with both new and enhanced complications. METHODOLOGY: We have used daily interferon-alpha at a dose of 5 MU for at least six months to treat patients with chronic hepatitis C in a community-based practice for the last five years. Treatment virologic response was defined as three consecutive monthly negative HCV-RNA results by RT-PCR. Following this, treatment was continued for an additional six months with a 'maintenance' dose of 2.5-5 MU interferon daily with intent to achieve a sustained response defined as HCV-RNA negativity six months after stopping maintenance therapy. A retrospective analysis of this experience is presented. RESULTS: Forty-two consecutive patients with chronic hepatitis C were treated. Eight (19%) discontinued treatment prematurely. Twenty-eight of the remaining 34 patients who completed treatment cleared the virus, yielding an end of treatment virologic response rate of 66.6%, based on the intent-to-treat principle. A sustained response was achieved in 15 (35.7%). Statistical analyses revealed maintenance therapy to be the significant variable associated with high sustained response in those patients who completed six months of maintenance therapy did significantly better (sustained response--72.7%) than those who discontinued maintenance therapy (sustained response--50%) (P < 0.05). CONCLUSIONS: High pre-treatment viral loads and normal pre-treatment serum ALT levels did not adversely affect outcomes. Thus, daily therapy at 5 MU interferon until three negative monthly HCV-RNA results are obtained, followed by an additional six months of maintenance therapy yields high end of treatment and sustained response rates. Unlike most studies in the literature these excellent results were achievable in a community-based practice.

Daily interferon monotherapy for chronic hepatitis C in patients with normal or near-normal serum alanine transaminase levels: a comparison of two protocols.

OBJECTIVES: Up to 30% of the 5 million patients with chronic hepatitis C in the United States have normal serum alanine transaminase (ALT) levels. These individuals have not been treated aggressively, and reported response rates have been low. No study has targeted patients treated in a community practice setting. METHODS: Consecutive patients with chronic hepatitis C with normal or near-normal serum ALT levels seen over a 2-year period in a community gastroenterology-hepatology practice were randomly assigned to receive either 3 MU or 6 MU daily interferon (IFN)-alpha-2a monotherapy for 12 months. RESULTS: Sixteen patients (8 in each treatment arm) qualified for study. End-of-treatment response was 87.5% with 6 MU IFN daily and 75% with 3 MU IFN daily, whereas sustained virologic response was 62.5% and 50%, respectively. Genotype 1 patients had an improved outcome with the higher 6 MU dose. CONCLUSIONS: Daily IFN monotherapy achieves high response rates in patients with chronic hepatitis C with normal or near-normal ALT. Present-day pegylated interferon regimes can be expected to be as effective.