Addition of pentoxifylline to pegylated interferon-alpha-2a and ribavirin improves sustained virological response to chronic hepatitis C virus: a randomized clinical trial.

BACKGROUND AND AIM: The commonly accepted treatment for hepatitis C virus (HCV) infection, pegylated interferon alpha (PEG INF-alpha) and ribavirin, leads to 50-60% of sustained virological response (SVR). On the other hand, pentoxifylline (PTX) possesses antiviral and hepatoprotector properties. AIM: To investigate whether the addition of PTX to conventional hepatitis C treatment increases SVR. MATERIAL AND METHODS: Seventy two patients of both genders were studied in a randomized fashion; the diagnosis of chronic HCV infection was made according to clinical and laboratory criteria and histopathologically classified according to METAVIR scoring system criteria. HCV viral load was tested by PCR, baseline, and after 6 months of treatment, as well as anti-HCV, anti-hepatitis B virus , and anti-human immunodeficiency virus antibodies by enzyme-linked immunosorbent assay. During 48 weeks, control group patients were treated with PEG INF-alpha- 2a plus ribavirin. PTX was administered to Experimental Group patients prior to the treatment. RESULTS: Demographic data were similar in both groups. Experimental- and control-group subjects were at F2 and F3 states according to the METAVIR classification. The most common HCV genotypes were 1a and 1b (39% in the control group in each case, and 42% in the experimental group in each case). At the end of the study, hepatic enzymes and viral load decreased in both groups to similar values. SVR in the experimental group increased significantly (p < 0.05) when compared with standard therapy alone. CONCLUSION: Addition of PTX to conventional chronic hepatitis C treatment may increase the percentage of patients with SVR.

Treatment of hepatocarcinoma with celecoxib and pentoxifylline: a case report / Manejo del hepatocarcinoma con celecoxib y pentoxifilina: reporte de un caso

Background: Hepatocellular carcinoma (HCC) is the sixth most frequent tumor worldwide and it is responsible for approximately 750 000 deaths each year. It is the third leading cause of cancer death in Mexico. Despite the existing therapeutic regimens, HCC has a poor prognosis with a life expectancy of approximately one month in advanced cases. The use of celecoxib and pentoxifylline has recently been reported in tumor patients with promising results due to its anti-inflammatory, antiangiogenic, antifibrotic and proapoptotic effects. Nonetheless, the combination of both drugs for the treatment of HCC has never been employed. Clinical case: 58-year-old male patient, who arrived to the examination room for presenting nausea, jaundice, asthenia, adynamia and encephalopathy grade I-II. The patient had a history of alcoholism for 47 years and diagnosis of cirrhosis in Child C stage. An image with focal lesion in the right lobe of 8 x 8 cm, which was highly vascularized, suggested HCC by means of imaging studies (ultrasound, computed axial tomography [CAT] and magnetic resonance imaging). Management began in January, 2015, and continues until today with 400 mg of pentoxifylline every 12 hours, 200 mg of celecoxib every 12 hours and vitamin supplements. Conclusion: After one month, patient showed a surprising response, reduction in tumor size almost in its entirety, improvement of clinical condition, and turned into Child A stage. Eight months after treatment it was observed by CAT that the tumor had practically disappeared. Patient has survived for more than two years. These results are encouraging; however, it is necessary to conduct multicenter studies that prove the efficacy of the treatment.

Introducción: El hepatocarcinoma (HPC) es el sexto tumor más frecuente a nivel mundial y provoca aproximadamente 750 000 muertes al año. Representa la tercera causa de muerte por cáncer en México. A pesar de los esquemas terapéuticos existentes, el pronóstico en el HPC es malo, con un promedio aproximado de vida de un mes en casos avanzados. Recientemente se ha reportado el uso de celecoxib y pentoxifilina en pacientes tumorales con resultados prometedores debido a sus efectos antiinflamatorios, antiangiogénicos, antifibróticos y proapoptóticos. Sin embargo, nunca han sido usados en combinación para el tratamiento de HPC. Caso clínico: Paciente masculino de 58 años que acudió a consulta por presentar náuseas, ictericia, astenia, adinamia y encefalopatía grado I-II; tenía antecedente de alcoholismo durante 47 años y diagnóstico de cirrosis en estadio Child C. Mediante ultrasonido, tomografía axial computarizada (TAC) y resonancia magnética se evidenció una imagen con lesión focal en lóbulo derecho de 8 x 8 cm, altamente vascularizada, sugestiva de HPC. Se inició manejo en enero de 2015 y el paciente continúa hasta la fecha con pentoxifilina (400 mg/12 h), celecoxib (200 mg/12 h) y suplementos vitamínicos. Conclusión: Después de un mes el paciente mostró una respuesta sorprendente, reducción del tamaño de la lesión casi en su totalidad, mejoría del estadio clínico y cambió a un estadio Child A. Ocho meses después de implementar el tratamiento se observó por medio de TAC que el tumor casi había desaparecido. El paciente ha sobrevivido por más de dos años. Los resultados son alentadores; sin embargo, es necesario realizar estudios multicéntricos que demuestren su real eficacia.