Phlebotomy Improves Therapeutic Response to Interferon in Patients with Chronic Hepatitis C: A Meta-Analysis of Six Prospective Randomized Controlled Trials

• Published in: Digestive diseases and sciences 2008-03, Vol.53 (3), p.815-822
• Main Authors: Desai, Tusar K., Jamil, Laith H., Balasubramaniam, Mamtha, Koff, Raymond, Bonkovsky, Herbert L.
• Format: Article
• Language: English
• Subjects: Antiviral Agents - therapeutic use; Biochemistry; Biological and medical sciences; Clinical Protocols; Combined Modality Therapy; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology; Hepacivirus - isolation & purification; Hepatitis C, Chronic - pathology; Hepatitis C, Chronic - therapy; Hepatitis C, Chronic - virology; Hepatology; Human viral diseases; Humans; Infectious diseases; Interferons - therapeutic use; Liver - pathology; Male; Medical sciences; Medicine; Medicine & Public Health; Oncology; Original Paper; Phlebotomy; Prospective Studies; Randomized Controlled Trials as Topic; Transplant Surgery; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Viral diseases; Viral hepatitis
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-007-9945-7

Prospective randomized controlled trials (RCTs) comparing phlebotomy and interferon (IFN) treatment to IFN alone in patients with chronic hepatitis C (CHC) have suggested a benefit for the phlebotomy group. However, statistical significance was achieved in only one of these trials. We performed a meta-analysis of RCTs comparing phlebotomy and IFN to IFN alone for the treatment of CHC. The MEDLINE database and Cochrane registry of controlled trials were searched using the key words “phlebotomy” and “treatment of hepatitis C.” Reference lists of review articles discussing the interaction between iron and CHC, and prospective RCTs comparing phlebotomy plus IFN therapy to IFN alone were searched to identify additional RCTs that compared phlebotomy plus IFN to IFN alone. Peto odds ratios with their 95% confidence intervals and Forrest plots were generated for each variable to assess the relationships among the studies that had provided that information. Statistical analysis was performed using Comprehensive META-Analysis version 2.0. Six prospective RCTs were identified: all used sustained viral response (SVR) as an endpoint. The three largest RCTs excluded patients with cirrhosis. Two RCTs specifically included only patients with either high ferritin or high hepatic iron content. IFN treatment regimes varied. Length of treatment varied between 6 and 12 months. The phlebotomy plus IFN group and the IFN group did not differ with respect to the percentage of patients with cirrhosis or genotype 1. SVR was attained in 50/182 (27%) patients in the phlebotomy plus IFN group, compared to 22/185 (12%) patients in the IFN group. Peto odds ratio for SVR in phlebotomy plus IFN group was 2.7; 95% CI 1.6–4.5, P