Interferão peguilado e ribavirina em doentes com hepatite crónica sem resposta sustentada ao interferão standard e ribavirina

R Freire, J. Mangualde, A. M. Vieira, C. Lobato, C. Pinho, A. Alves, F. Augusto, A. P. Oliveira

 

 Resumo

Introdução: Apesar de submetidos a tratamento, muitos dos doentes com hepatite C crónica permanecem infectados. Com o interferão peguilado e ribavirina, a resposta virológica sustentada ultrapassou os 50%, um acréscimo de 17 a 25% comparativamente ao interferão standard e ribavirina. Tal facto poderá fundamentar o retratamento dos doentes sem resposta a tratamentos anteriores.

Objectivos: Avaliar a eficácia do tratamento com interferão peguilado e ribavirina, após falência do interferão standard e ribavirina. Identificar factores preditivos de boa resposta.

Doentes e Métodos: Análise retrospectiva dos doentes retratados com interferão peguilado e ribavirina após falência do interferão standard e ribavirina.

Resultados: Identificaram-se 27 doentes (78% do sexo masculino, média de idades de 43 anos). O genótipo 1 foi identificado em 23 doentes. Catorze tinham virémias superiores a 500.000 UI/L. Quinze doentes tinham efectuado interferão standard em monoterapia. Todos cumpriram tratamento com interferão standard e ribavirina, sendo a resposta nula em dois terços. Com o retratamento (interferão peguilado e ribavirina), a resposta sustentada atingiu 25,9% (7 doentes). Os factores preditivos de boa resposta foram: resposta virológica precoce ao retratamento e ausência de curso prévio de interferão em monoterapia. Conclusões: O retratamento deverá ser considerado, sobretudo se estiverem presentes os factores preditivos de boa resposta.

 

 

Summary

Introduction: Treatment failures were frequent before peginterferon and ribavirin become standard therapy for chronic hepatitis C. Overall, a sustained virologic response can now be achieved in over 50% of patients, a 17-25% higher rate than that with standard interferon and ribavirin, which may sustain a retreatment strategy for patients with no response to previous therapies.

Aims: To evaluate the effectiveness of retreatment with peginterferon and ribavirin in patients who failed treatment with standard interferon and ribavirin and to identify factors associated with a favourable outcome.

Patients and Methods: Retrospective analysis of patients retreated with peginterferon and ribavirin after treatment failure with standard interferon and ribavirin.

Results: Twenty-seven patients were included (78% male, mean age of 43 years, 85% with genotype 1). Serum HCV RNA was higher than 500.000 IU/L in 14 patients. Fifteen patients had been previously treated with standard interferon monotherapy. All were treated with, and failed, standard interferon and ribavirin. With retreatment (peginterferon and ribavirin), a sustained response was achieved in 25,9% (7 patients). Factors associated with a favourable outcome were early virologic response on retreatment and absence of previous interferon monotherapy.

Conclusions: Retreatment should be considered, particularly in selected patients with factors predictive of a favourable outcome.

 

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Recebido para publicação: 16/01/2006

Aceite para publicação: 01/03/2006