Interferon Treatment Duration in Patients With Chronic Delta Hepatitis and its Effect on the Natural Course of the Disease

• Published in: The Journal of infectious diseases 2018-03, Vol.217 (8), p.1184-1192
• Main Authors: Yurdaydin, Cihan, Keskin, Onur, Kalkan, Çağdaş, Karakaya, Fatih, Çalişkan, Aysun, Kabaçam, Gökhan, Önder, F Oğuz, Karatayli, Senem, Karatayli, Ersin, Deda, Xheni, Bozkaya, Hakan, Bozdayi, A Mithat, Idilman, Ramazan
• Format: Article
• Language: English
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jix656

Abstract Background Interferon is the only treatment option in chronic delta hepatitis (CDH). A CDH database (333 patients, 161 with interferon treatment history) was analyzed for effects of treatment duration on virologic response and clinical outcomes. Methods Ninety-nine CDH patients who received at least 6 months of interferon were selected. Maintained virologic response (MVR) was defined as hepatitis D virus RNA negative for 2 years after treatment discontinuation. Cumulative median interferon treatment duration was 24 months (range 6–126 months), with a median of 2 courses (range 1–8). Post-treatment median follow-up was 55 months (24–225 months). Results Thirty-five patients achieved MVR. Cumulative probability of MVR increased with treatment duration and reached 50% at 5 years. Patients with MVR were less likely to die from liver disease or develop complications compared to patients without MVR (P = .032, P = .006, respectively). Cirrhosis at baseline and no response to therapy (odds ratio 16.1 and 5.23, respectively) predicted an adverse endpoint. Hepatitis B surface antigen clearance occurred in 37% of patients with MVR. Conclusion Viral response to interferon increases with treatment duration and favorably affects the natural course of disease. Interferon treatment duration has to be individualized with careful post-treatment assessment. Optimal interferon treatment duration is unknown in chronic delta hepatitis. This study indicated that some patients benefit from early and prolonged treatment, and some with virologic response cleared hepatitis B surface antigen. In patients with virologic response, liver-related death decreased.