Efficacy of double filtration plasmapheresis with pegylated interferon/ribavirin therapy for intractable chronic hepatitis C patients and hepatitis C patients with combined liver cirrhosis by HBV, leading to early viral elimination.

BACKGROUND/AIMS: Therapeutic results for patients with hepatitis C and B complex or patients with genotype lb high viral load treatment-resistant hepatitis C are still not sufficient. The therapeutic effects of concomitant treatment of such intractable patients with double-filtration plasmapheresis (DFPP) and pegylated interferon (PEG-IFN) alpha 2a/ribavirin (RBV) therapy were investigated.

METHODOLOGY: The subjects were one patient with genotype 2a hepatitis C combined with liver cirrhosis by HBV and 12 patients with retreated hepatitis C (genotype 2a: two patients, genotype 1b: 10 patients). All subjects were given PEG-IFNalpha2a/RBV therapy (up to 24 weeks for genotype 2a and from 48 to 72 weeks for genotype 1b) and DFPP from the start of treatment for a total of five times. The disappearance of HCV-RNA, hepatic function and peripheral blood were observed with time.

RESULTS: In seven of the 13 patients, HCV-RNA became negative by week 4 of treatment and three became negative by week 12. The remaining three patients became HCV-RNA negative by week 20. In the patient with hepatitis C (genotype 2a) combined with liver cirrhosis by HBV, HBV became negative in week 1 of treatment and HCV-RNA was negative by week 2. Sustained viral response (SVR) was detected in this patient with hepatitis C (genotype 2a) and liver cirrhosis by HBV and in two of the genotype 2a hepatitis C patients. Two of the genotype 1b hepatitis C patients are still HCV-RNA negative at 3 months after completion of treatment and eight patients are currently under observation during treatment.

CONCLUSIONS: Concomitant treatment with PEG-IFNalpha2a/RBV and DFPP is a new modality of hepatitis treatment that causes HCV-RNA to become negative or markedly reduced at an early stage of treatment and induces SVR.