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Peginterferon/ribavirin effective for children, adolescents with chronic HCV

Treatment of chronic hepatitis C with pegylated interferon and ribavirin is effective and relatively safe for children and adolescents, according to recent results.

Researchers performed a systematic review and meta-analysis of eight trials assessing the use of pegylated interferon (PEG-IFN) alfa-2a or 2b with ribavirin (RBV) in patients aged 3 to 18 years with chronic HCV. Complete early virologic response (EVR) was defined as undetectable HCV RNA after 12 weeks of treatment, and sustained virologic response (SVR) was defined as undetectable RNA after 24 weeks of post-treatment follow-up.

Across all cohorts, EVR occurred in 70% of patients and SVR occurred in 58%, with higher response rates among participants with genotypes 2 (87% of cases) or 3 (89%) than those with genotypes 1 (61%) or 4 (52%). Relapse occurred in 7% of cases.

Lack of response in 15% of participants resulted in discontinuation of treatment, while 4% required discontinuation because of adverse events and 4% discontinued as a result of virologic breakthrough. Common adverse events included leukopenia (52%), neutropenia (32%), erythema at the injection site (27%), alopecia (13%) and anemia (11%).

Investigators noted that, across five studies with evaluable data, some growth inhibition was observed during treatment, and it returned to normal upon treatment cessation. In one randomized controlled trial, some participants who had experienced growth inhibition had not returned to baseline height-for-age after 2 years of follow-up.

Edward J. Mills

“In the rare instance where a child is identified to be progressing toward advanced liver disease from HCV … our work demonstrates that PEG-IFN and RBV can be used relatively safely and with a reasonable hope of cure,” researcher Edward J. Mills, PhD, department of clinical epidemiology and biostatistics at McMaster University in Hamilton, Canada, told Healio.com. He also noted that combination direct-acting antiviral regimens may provide better therapeutic options in the future. “[IFN-based] medications do cause multiple side effects and adverse events, which is not ideal in any population; in particular, a population of children.”

Disclosure: See the study for a full list of relevant disclosures.