Chronic hepatitis C genotype 1 patients with insulin resistance treated with pioglitazone and peginterferon alpha-2a plus ribavirin
| Autor: | Muhammed Y. Sheikh, Prashant K. Pandya, Fayez M. Hamzeh, Jian Han, Stephen A. Harrison, John M. Vierling |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Genotype medicine.medical_treatment Hepacivirus Antiviral Agents Gastroenterology Polyethylene Glycols chemistry.chemical_compound Insulin resistance Risk Factors Internal medicine Diabetes mellitus Multicenter trial Ribavirin medicine Humans Hypoglycemic Agents Pioglitazone Hepatology business.industry Insulin Interferon-alpha virus diseases Hepatitis C Hepatitis C Chronic Middle Aged medicine.disease Recombinant Proteins Treatment Outcome Endocrinology Diabetes Mellitus Type 2 chemistry Drug Therapy Combination Female Thiazolidinediones Insulin Resistance business Follow-Up Studies medicine.drug |
| Zdroj: | Hepatology. 56:464-473 |
| ISSN: | 0270-9139 |
| DOI: | 10.1002/hep.25661 |
| Popis: | Patients with chronic hepatitis C and insulin resistance are less likely to respond to anti-hepatitis C virus (HCV) therapy and are at risk for more rapid fibrosis progression. Coadministration of pioglitazone with peginterferon/ribavirin improves insulin sensitivity and increases virologic response rates in insulin-resistant HCV genotype 4 patients, but it is unclear whether this finding applies to genotype 1 patients. For this reason we randomized treatment-naive HCV genotype 1 patients with insulin resistance to receive either standard care (peginterferon alpha-2a plus ribavirin for 48 weeks, n = 73) or pioglitazone 30-45 mg/day plus standard care (n = 77) in an open-label multicenter trial. Patients randomized to pioglitazone received the drug during a 16-week run-in phase, the 48-week standard-care phase, and the 24-week untreated follow-up phase. Pioglitazone treatment improved hemoglobin A1c (HbA1c), plasma glucose, insulin levels, and homeostasis model assessment of insulin resistance score and increased serum adiponectin levels during the 16-week run-in phase and maintained these improvements during the standard-care phase. However, we observed no statistically significant difference between the two groups in the primary efficacy endpoint, the decrease from baseline to Week 12 of peginterferon alpha-2a/ribavirin treatment in mean log10 HCV RNA titer (−3.5 ± 1.71 and −3.7 ± 1.62 IU/mL in the pioglitazone and standard-care groups, respectively, Δ = 0.21 IU/mL, P = 0.4394). Conclusion: Treatment with pioglitazone before and during treatment with peginterferon alpha-2a plus ribavirin improved several indices of glycemic control in patients with chronic hepatitis C and insulin resistance, but did not improve virologic response rates compared with peginterferon alpha-2a plus ribavirin alone. (HEPATOLOGY 2012) |
| Databáze: | OpenAIRE |
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