Efficacy of adding metformin to pegylated interferon and ribavirin in treatment naive patients with chronic hepatitis C: a randomized double-blind controlled trial

Evidence indicates that insulin resistance results in poor sustained viral response [SVR] in patients with chronic hepatitis C [CHC]. Metformin is an oral hypoglycemic agent which improves insulin resistance. We sought to determine if the addition of metformin to the treatment regimen could improve SVR in treatment-naïve CHC patients in a randomized, double-blind, placebo-controlled trial. We randomized 140 consecutive CHC patients to receive either metformin 500 mg three times a day or placebo in addition to pegylated interferon [PEG-IFN] and ribavirin [RBV]. Only treatment-naïve subjects aged between 15 and 65 years of age were included. SVR was defined as no detectable HCV RNA six months after the end of treatment. Subjects who received at least one dose of PEG-IFN were included in the final analysis. The SVR rate in the metformin group was 75% versus 79% in controls [intention-to-treat] which was not significantly different. Also, the difference between the placebo and metformin group was not significant in subsets of different genotypes or those with homeostasis model assessment of insulin resistance [HOMA-IR] levels greater than 2 or body mass index greater than 25. The most common complaint was gastrointestinal discomfort [13% in metformin group versus 4% in controls; p=0.002] that lead to discontinuation of metformin in 8 participants. Although triple therapy with metformin, PEG-IFN and RBV is relatively well tolerated, the addition of metformin did not significantly improve viral response in CHC patients.

Exacerbation of skin lesions in a 50 year old man with psoriasis during treatment by pegylated interferon

Chronic hepatitis C might lead to several immunological dysfunctions. Studies have shown a positive association between hepatitis C virus [HCV] infection and psoriasis. These results suggest that the infection may be one of the triggering factors for the development or exacerbation of psoriasis. Here, we present a case of chronic HCV infection with psoriasis who developed exacerbation of skin lesions during therapy with peginterferon alpha-2a plus ribavirin. We discuss the management, course and results of HCV treatment in this patient

Bell's palsy associated with chronic HCV infection before and during peginterferon alfa and ribavirin therapy

Neuropsychiatric side effects of peginterferon-alpha [EG-IFN-alpha] therapy consist of a large spectrum of symptoms. Organic personality syndrome, organic affective syndrome, psychotic manifestations and seizures are more common side effects of PEG-IFN-alpha whereas cranial neuropathy and movement disorders are less common. Bell's palsy is often idiopathic, but has been linked to some viral infections, particularly with herpes viruses. Other infections, such as human immunodeficiency virus infection and Lyme disease, may also lead to idiopathic facial paralysis. Neither acute nor chronic Hepatitis C infection has been implicated previously in Bell's palsy, but PEG-IFN- alpha may play a role. Two patients with CHC who developed Bell's palsy before and during treatment with PEG-IFN- alpha and Ribavirin are presented here

Pegaferon in hepatitis C: results of a multicenter study

Chronic hepatitis C [CHC] is a major contributor to cirrhosis and hepatocellular carcinoma and major global public health problem that causes mortality in both developed and developing countries. For the past decade, treatment with pegylated interferon [peg interferon alpha] ribavirin [RBV] has been associated with rates of sustained virologic response of /= 800,000 IU/ml before starting treatment. "As-treated analysis" indicated that a total of 168 [77.8%] patients achieved sustained viral response [SVR, undetectable plasma HCV RNA 24 weeks after the last planned dose of study treatment]. This study, with a larger number of participants, confirms the results of a previous study by the authors that Pegaferon, a PEG-IFN alpha 2a locally produced in Iran, is effective in treatment-na‹ve CHC patients