ABSTRACT
No disponible
Subject(s)
Aged, 80 and over , Aged , Humans , Male , Lymphoma/diagnosis , Colonic Neoplasms/diagnosis , Intussusception/etiology , Diagnosis, Differential , ColonoscopySubject(s)
Colonic Diseases/etiology , Colonic Neoplasms/complications , Ileal Diseases/etiology , Ileocecal Valve , Intussusception/etiology , Lymphoma, Large B-Cell, Diffuse/complications , Lymphoma, Mantle-Cell/complications , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Colonic Neoplasms/diagnostic imaging , Colonography, Computed Tomographic , Combined Modality Therapy , Humans , Ileocecal Valve/diagnostic imaging , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/surgery , Lymphoma, Mantle-Cell/diagnostic imaging , Lymphoma, Mantle-Cell/drug therapy , Lymphoma, Mantle-Cell/surgery , Male , Remission Induction , Tomography, X-Ray ComputedABSTRACT
The treatment of chronic hepatitis C (CHC) is still far from optimal, particularly for those subpopulations that do not respond to the standard combination therapy with Interferon-alpha (IFNalpha) plus ribavirin. Although in some cases the use of higher doses or longer treatment periods may be effective, these approaches are generally associated with a higher incidence of adverse events, which may either lead to a reduction in patient compliance or require drug withdrawal. IFNbeta could represent an interesting alternative for treating CHC patients. Controversial data about IFNbeta efficacy in CHC exist, the main reason being that many results stem from pilot studies with small cohorts of patients. However, promising results have been obtained in some subgroups of patients that fail to respond to IFNalpha. Additionally, the good tolerability of IFNbeta represents an important advantage of the drug. The rates of dropouts in controlled clinical trials, as well as the need for dose reductions or treatment discontinuation are very low. It might be worth assessing the value of IFNbeta plus ribavirin in randomized studies with a larger cohort of patients, not eligible or not tolerating standard therapy, and for non-responders.
Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Interferon-beta/therapeutic use , Antiviral Agents/adverse effects , Drug Therapy, Combination , Drug Tolerance , Hepatitis C , Humans , Interferon-alpha/therapeutic use , Interferon-beta/adverse effects , Randomized Controlled Trials as Topic , Ribavirin/therapeutic useABSTRACT
In the absence of antiviral treatment, chronic hepatitis C virus (HCV) infection is a liver disease characterized by the development of necroinflammatory changes and progressive liver fibrosis, leading to cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC). The approval of ribavirin in combination therapy regimens with interferon (IFN) dramatically improved therapy. Another advance was the introduction of pegylated IFNs, which allow a once-weekly subcutaneous administration and show more favorable pharmacokinetics and greater efficacy. Two forms are available: pegylated IFN alpha-2b (12 kDa) (1.5 microg/kg) and pegylated IFN alpha-2a (40 kDa) (fixed dosage of 180 microg). Ribavirin is administered orally, at doses > or =10.6 mg/kg, resulting in higher sustained virological responses (SVR) than IFN monotherapy. The highest SVR rates are attained with pegylated IFNs in combination with ribavirin. Factors associated with treatment outcome include HCV genotype, viral load, body weight, age, cirrhosis or bridging fibrosis, coinfection with HIV or hepatitis B virus, and treatment adherence and tolerance. Currently, the main therapeutic challenges ahead are: (a) the dosage optimization of pegylated IFNs and ribavirin according to the patients' characteristics; and (b) to evaluate the efficacy and safety of this combination therapy for difficult-to-treat patients, such as nonresponders, cirrhotics, transplant recipients, renal disease patients or those coinfected with HIV.
