More than half of 61 children and adolescents infected with chronic hepatitis C achieved a sustained viral response after treatment with Peginterferon-alfa-2b ( Peg-Intron ) and Ribavirin.

Peginterferon plus Ribavirin is standard therapy for adults with chronic hepatitis C. As no data are available for children, researchers, led by Stefan Wirth from HELIOS Klinikum Wuppertal in Germany, evaluated the efficacy and tolerability of the therapy in infected children.

A total of 62 children and adolescents ranging in age from 2 to 17 years , with chronic hepatitis C were enrolled.

The patients were treated with a subcutaneous dose of Peginterferon-alfa-2b once a week and a daily oral dose of Ribavirin.

One patient dropped out after developing an allergic reaction at the injection site.
Twenty-three children discontinued therapy after 6 months according to study protocol.

Sustained viral response was documented in 22 ( 47.8% )of 46 patients with genotype 1, in 13 ( 100% ) of 13 with genotype 2 or 3, in 1 of 2 with genotype 4, in 19 ( 70.4% ).

The study also showed that children who had been infected via needle ( for example, from a blood transfusion ) responded better to treatment than those who were infected by their mothers at birth.

The researchers found that patients with normal liver enzyme levels before treatment responded better than those with elevated levels.

Most of the children experienced side effects from the treatment ranging from mild flu-like symptoms to weight loss to leucopenia; 10.3% developed thyroid autoantibodies and thyroid dysfunction.
One girl developed diabetes mellitus, a rare but permanent side effect associated with Interferon. She continued treatment and achieved sustained viral response.
All other side effects resolved when the treatment protocol ended.

The data of this uncontrolled study confirms that treatment with recombinant Peginterferon-alfa-2b plus Ribavirin in children and adolescents with chronic hepatitis C yielded an encouraging result with 59 percent sustained viral response.

The authors also emphasized the importance of the high viral response rate of children whose liver enzyme tests were normal before treatment began, which suggests that such children should not be excluded from treatment.
The lower response rates among children with genotype 1 and in those who were infected by their mothers implies a need for additional research.

Source: Hepatology, 2005


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