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Interferon for Hepatitis C Virus in Hemodialysis—an Individual Patient Meta-analysis of Factors Associated with Sustained Virological Response

Craig E. Gordon^*, Katrin Uhlig^*, Joseph Lau, Christopher H. Schmid, Andrew S. Levey^*, and John B. Wong

^* Division of Nephrology, Division of Clinical Care Research, Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, Massachusetts

Correspondence: Dr. Craig E. Gordon, Renal Section, Boston University Medical Center, Albany Street, 5^th floor, Boston, MA 02118. Phone: 617-638-7392; Fax: 617-638-7236; E-mail: craig.gordon{at}bmc.org

Background and objectives: Hepatitis C virus (HCV) infection is prevalent in hemodialysis patients and causes excess mortality. Interferon (IFN) treatment of chronic HCV infection in hemodialysis patients results in high sustained virological response (SVR) rates 6 mo after treatment. The authors aimed to identify factors associated with SVR in hemodialysis patients through analysis of individual patient data obtained from systematic review of published literature.

Design, setting, participants & measurements: Medline was searched from 1966 through February 2009, and prospective studies describing IFN treatment of hemodialysis patients with chronic HCV infection with published individual patient data were included. To identify factors associated with SVR, logistic regression was applied with adjustment for study.

Results: Twenty studies of IFN treatment provided data on 428 patients. Overall SVR was 45% and in univariate analyses was higher with: 1) three million units or higher three times weekly of IFN; 2) treatment for at least 6 mo; 3) treatment completion; 4) lower baseline HCV RNA; 5) female gender; and 6) early virological negativity. Although limited by missing data, these relationships persisted in multivariate regression.

Conclusions: SVR is more likely with larger IFN dose, longer treatment duration, treatment completion, female gender, lower HCV RNA and early virological negativity. For appropriate treatment candidates, regimens should consist of three million units of IFN three times weekly for at least 6 mo, with patients encouraged to complete the full course.