[Effect of iron depletion on long-term response to interferon in patients with chronic hepatitis C with increased plasma iron without accumulation of liver iron]. / Effetto della ferrodeplezione sulla risposta a lungo termine all'interferone in pazienti affetti da epatite cronica C con aumentato ferro plasmatico senza accumulo di ferro epatico.

We studied the effect of iron depletion on the response to subsequent interferon therapy in a population of 83 patients affected by chronic hepatitis C who had not previously undergone any specific therapy and who had laboratory confirmation of iron overload (serum ferritin > 400 ng/mL in the males and > 300 ng/mL in the females). The population was divided into two homogeneous groups. Group A consisted of 43 patients who underwent phlebotomy (300 mL every 10-15 days for an average total of 8 sessions) until serum ferritin levels of < 100 ng/mL were obtained. The 40 patients in Group B were treated with interferon without prior iron depletion. Iron depletion alone, induced in Group A, brought about a highly significant (p < 0.01) reduction of alanine aminotransferase serum values: from 165 U/L (range 60-370 U/L) to 67 U/L (range 27-158 U/L). Seventy-six patients completed therapy and follow-up: a complete and sustained response was obtained in 12/39 cases in Group A and in 6/37 cases in Group B (p < 0.05). Iron depletion carried out in patients with chronic hepatitis C, who have elevated base values of serum ferritin, induces a significant reduction in necro-inflammatory activity (notable decrease in average alanine aminotransferase values) and improves the response to subsequent treatment with interferon, although it does not modify the viral load.

Management of patients with HCV infection poorly tolerant to recombinant interferon alpha.

BACKGROUND/AIMS: To evaluate leukocyte interferon-alpha tolerability and efficacy in the retreatment of patients poorly tolerant to recombinant interferon-alpha. METHODOLOGY: Patients with chronic hepatitis C, poorly tolerant to a previous interferon-alpha treatment (118 patients; 73 "relapsers": Group I; 45 "non-responders": Group II) were retreated with 6 MU tiw of leukocyte interferon-alpha for 6 months and then followed-up for 12-34 months. Only patients with complete regression of any previous interferon-related adverse event were included. RESULTS: Three patients dropped out due to recurrence of a severe depressive syndrome. In 86/115 patients (75%) no significant lifestyle changes versus baseline were observed during retreatment, while 29 subjects experienced a moderately negative interference on their living habits. The different influence on the patients' quality of life of leukocyte interferon in comparison with the previous treatment was significant (P < 0.001). In 98 patients the interferon-related adverse events significantly decreased. After 12 months of follow-up, a sustained biochemical response was observed in 40 patients (Group I:31; Group II:9), and a persistent virological response in 28 (Group I:23; Group II:5). CONCLUSIONS: The good compliance with leukocyte interferon administration shown by poorly tolerant patients, non-responders/relapsers to recombinant interferon, permitted a retreatment with full doses, so increasing the chance to obtain a larger number of sustained responses.

Severe postpartum hypertension and reversible cerebral angiopathy associated with ergot derivative (methergoline) administration.

A 36-year-old woman (gravida 2, para 2) delivered a healthy child by cesarean section at the 37th week of an unremarkable gestation. Blood pressure remained within normal range throughout the pregnancy, surgery, and for the 9 following days. On day 10, about 36 hours after the initiation of oral methergoline to suppress lactation, the patient complained of severe posterior headache, flashing scotomata, hypertension, tonico-clonic seizures and then homonymous left hemianopsia and hemiparesis. Blood pressure monitoring confirmed intermittent and severe hypertension. Angiography demonstrated diffuse narrowing of the small and medium cerebral arteries. Transcranial Doppler ultrasound examination disclosed a bilateral increase in mean flow velocity. Progressive normalization of blood pressure, obtained with labetalol and oral clonidine, was accompanied by amelioration of the neurological deficits until a complete recovery and normalization of transcranial Doppler flow velocity occurred. This case provides further evidences that hypertension might play a major pathogenetic role in reversible cerebral angiopathy. Some ergot derivatives (including methergoline) might trigger the initial rise in blood pressure.

[The retreatment with natural leukocyte interferon alfa-n3 of chronic hepatitis C patients: the intolerant and nonresponsive results to prior treatment with recombinant alfa interferon]. / Ritrattamento con interferone naturale leucocitario alfa-n3 di pazienti con epatite cronica C: risultati intolleranti e non responsivi a precedente trattamento con interferone alfa ricombinante.

To evaluate leukocyte interferon alpha-n3 tolerability and efficacy in the retreatment of patients with chronic hepatitis C poorly tolerant to previous treatment with recombinant interferon alpha, 142 patients (73 "relapsers" and 69 "nonresponders") were retreated with leukocyte interferon alpha-n3 (6 MU thrice weekly for 6 months) and followed up for 12-42 months. Only patients with complete regression of any previous interferon-related adverse events were included. Three patients dropped out due to recurrence of a severe depressive syndrome. In 104/139 patients (75%) no significant life-style changes vs baseline were observed during retreatment, while 35 subjects experienced moderately negative interference with their living habits. The different influence on the patients' quality of life during leukocyte interferon alpha-n3 treatment in comparison with the previous treatment was significant. In 118 patients (85%) the interferon-related adverse events significantly decreased. After 12 months of follow-up, a sustained biochemical response was observed in 48 patients (35%), and a persistent biochemical and virological response was seen in 33 (23%). The good compliance with leukocyte interferon alpha-n3 administration shown by poorly tolerant patients, "relapsers/nonresponders" to recombinant interferon, permitted retreatment with full doses and thus increased the chance of obtaining a larger number of sustained responses.

Prolonged treatment with ursodeoxycholic acid for primary biliary cirrhosis.

Eighteen patients affected with biopsy-proved primary biliary cirrhosis (PBC) (histological stage III and IV) received ursodeoxicholic acid (UDCA) 600 mg for 1 year. Signs and symptoms and biochemical tests (glutamic and oxalcetic transaminase, glutamic and pyruvic transaminase, bilirubine, gamma-glutamyl transpeptidase, alkaline phosphatase, leucine aminopeptidase, bile acids, plasma proteins electrophoresis, immunoglubulins A, G and M) and antimitochondrial antibodies were evaluated before the treatment and every four months during the treatment. The results were compared with those obtained in 8 untreated patients affected PBC. The control group of patients were comparable (as far as age, histological stage, biochemical tests are concerned) to the group who received UDCA. Bilirubine, ALP, gamma-GT and LAP decreased during the treatment with UDCA and remained lower than baseline values until the end of the observation (12 months), while no changes occurred in the untreated patients. Both in the treated and untreated group plasma protein electrophoresis, serum immunoglubulins A, G and M remained unchanged, as well as anti-mitochondrial antibody. A moderate reduction of transaminases and bile acids was observed in the group of patients receiving UDCA but it did not reach statistical significance. In 16 out of the 18 treated patients pruritus disappeared and resulted diminished in the remaining 2 patients. No significant amelioration of pruritus was observed in the patients who did not receive UDCA. In conclusion, our data show that prolonged treatment with UDCA drastically reduces pruritus and improves cholestasis biochemical tests in patients affected with symptomatic PBC.(ABSTRACT TRUNCATED AT 250 WORDS)