Phlebotomy Improves Chronic Hepatitis C

Phlebotomy Improves Chronic Hepatitis C

Dig Dis Sci. 2008 Mar;53(3):815-22. Epub 2007 Sep 12. Links
Phlebotomy improves therapeutic response to interferon in patients
with chronic hepatitis C: a meta-analysis of six prospective
randomized controlled trials.Desai TK, Jamil LH, Balasubramaniam M,
Koff R, Bonkovsky HL.
William Beaumont Hospital, Royal Oak, MI, USA. tusardesai@aol . com

Prospective randomized controlled trials (RCTs) comparing phlebotomy
and interferon (IFN) treatment to IFN alone in patients with chronic
hepatitis C (CHC) have suggested a benefit for the phlebotomy group.
However, statistical significance was achieved in only one of these
trials. We performed a meta-analysis of RCTs comparing phlebotomy and
IFN to IFN alone for the treatment of CHC. The MEDLINE database and
Cochrane registry of controlled trials were searched using the key
words "phlebotomy" and "treatment of hepatitis C." Reference lists of
review articles discussing the interaction between iron and CHC, and
prospective RCTs comparing phlebotomy plus IFN therapy to IFN alone
were searched to identify additional RCTs that compared phlebotomy
plus IFN to IFN alone. Peto odds ratios with their 95% confidence
intervals and Forrest plots were generated for each variable to assess
the relationships among the studies that had provided that
information. Statistical analysis was performed using Comprehensive
META-Analysis version 2.0. Six prospective RCTs were identified: all
used sustained viral response (SVR) as an endpoint. The three largest
RCTs excluded patients with cirrhosis. Two RCTs specifically included
only patients with either high ferritin or high hepatic iron content.
IFN treatment regimes varied. Length of treatment varied between 6 and
12 months. The phlebotomy plus IFN group and the IFN group did not
differ with respect to the percentage of patients with cirrhosis or
genotype 1. SVR was attained in 50/182 (27%) patients in the
phlebotomy plus IFN group, compared to 22/185 (12%) patients in the
IFN group. Peto odds ratio for SVR in phlebotomy plus IFN group was
2.7; 95% CI 1.6-4.5, P < 0.0001. All five RCTs published in manuscript
form showed a trend towards a benefit from the phlebotomy plus IFN in
attaining SVR, and the results of the meta-analysis were not dependent
on any single RCT, since excluding any single RCT did not change the
results. Phlebotomy improves the SVR in response to IFN treatment in
patients with CHC. Confirmation of this will require RCT with detailed
pre-treatment iron studies and appropriately powered to demonstrate a
statistically significant benefit.

PMID: 17846887 [PubMed - in process]

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