Pilot Results: Pre-Treatment with Deferasirox Increases the Chances of Rapid Viral Response in Patients with Chronic Hepatitis C Infection Treated with PEG-Interferon/Ribavirin.

Chronic hepatitis C infection [CHCV] is a major cause of morbidity and mortality. It is treated with a combination of interferon and ribavirin [INF/RIBV] for 1 year in strain 1 & 4 prevalent in our geographic area ¹. Iron overload is an important cofactor of disease outcome, enhancing inflammation, fibrosis and cirrhosis and predisposing to hepatocellular carcinoma. It also affects the response to conventional therapy^2–,3. We evaluated the impact of pre-treatment iron chelation using deferasirox on the outcome of combination therapy (160μg PEG-Interferon α-2-a (Reiferon-Retard) and ribavirin) in terms of early viral response defined as clearance or 2 log reduction in viral load at 12 weeks and rapid viral response defined as viral clearance by four weeks. The latter may imply a shortened duration of therapy to 6 months rather than a year, improving cost effectiveness and reducing side effects ^4,5. The study included 30 patients with CHCV candidates for INF/RIBV therapy with a Metavir score of less than F3 by liver biopsy or fibrotest. The mean serum ferritin of patients prior to therapy was 520+/−98 ng/ml. Ten patients were subjected to iron chelation using deferasirox (15mg/Kg/day p.o.) for 6–8 weeks prior initiation of therapy (group I), bringing their serum ferritin to 309+/−74 ng/ml, whereas 20 patients started therapy without pre-treatment chelation (group II). Patients were followed up periodically both clinically and laboratory. HCV PCR both quantitative and qualitative were conducted at week 4 and 12. In 7 patients (70%) from group I, early viral clearance at 12 weeks, was reported compared to 12 (60%) in group II (p>0.05). Six patients out of the 7 cleared in group I and 6 patients out of the 12 in group II (p<0.01) had a rapid virologic response with complete viral clearance at 4 weeks. Pre-treatment with deferasirox may improve early viral response rates. It seems to favor rapid virologic response in CHCV patients treated with INF/RIBV with a potential shorter duration of therapy, significant cost reduction and less side effects. Larger studies are needed to confirm the results of this pilot work.