Original article
Pancreas, biliary tract, and liver
Efficacy and Safety of Treatment of Hepatitis C in Patients With Inflammatory Bowel Disease

https://doi.org/10.1016/j.cgh.2013.07.014Get rights and content

Background & Aims

There is uncertainty about the efficacy and safety of treatment for hepatitis C virus (HCV) infection in patients with inflammatory bowel disease (IBD). IBD can become exacerbated during treatment with interferon (IFN), and serious adverse events, such as pancytopenia or hepatotoxicity, can be compounded by drug interactions. We investigated the risk of exacerbation of IBD during HCV therapy and the rate of adverse effects of concomitant therapy for HCV and IBD. We also evaluated the efficacy of HCV treatment in the IBD population.

Methods

We conducted a retrospective review of all patients who underwent IFN-based treatment for HCV at the Mayo Clinic in Rochester, Minnesota from 2001 to 2012. Exacerbation of IBD was evaluated by clinical, endoscopic, and histologic parameters during antiviral therapy and the ensuing 12 months. Hematologic toxicity was assessed by levels of all 3 cell lineages at baseline and during therapy. Efficacy of antiviral treatment was assessed by serum levels of HCV RNA until 24 weeks after completion of therapy. We also conducted a detailed MEDLINE database search and reviewed the literature on this topic.

Results

We identified 15 subjects with concomitant IBD (8 with ulcerative colitis and 7 with Crohn's disease). Only 1 patient experienced exacerbation of the disease during therapy; symptoms were controlled with mesalamine enemas. Another patient developed a flare shortly after completing antiviral therapy; symptoms returned spontaneously to baseline 2 weeks later. All subjects experienced an anticipated degree of pancytopenia while on IFN-based therapy. The rate of sustained virologic response was 67%. A concise review of available literature regarding the safety and efficacy of HCV treatment in IBD patients is also presented; although limited, the published data appear to support the safety of treatment with IFN in patients whose IBD is under control.

Conclusions

In conjunction with data from the literature, our findings indicate that the efficacy and safety of HCV therapy with IFN and ribavirin for patients with IBD are comparable to those of subjects without IBD.

Section snippets

Patients and Methods

We conducted a retrospective review of all patients who underwent IFN-based treatment for HCV at Mayo Clinic, Rochester, Minnesota, between 2001 and 2012. The study was approved by the Institutional Review Board of Mayo Clinic.

Exacerbation of IBD was evaluated by clinical, endoscopic, and histologic parameters during antiviral therapy and the ensuing 12 months. Clinical assessment was extracted from medical records documented during the aforementioned period by any medical provider. Management

Exacerbation of Inflammatory Bowel Disease During Hepatitis C Virus Therapy

Of 1017 patients treated for HCV during the study period, 15 had concomitant IBD (8 with ulcerative colitis [UC] and 7 with Crohn's disease [CD]). The median age at initiation of antiviral therapy was 53 years (range, 30–68). Two patients received antiviral therapy twice; therefore, 17 treatment courses were observed. The bowel disease characteristics of the study population are summarized in Table 1, and the liver disease characteristics are summarized in Table 2.

All subjects had inactive

Risk of Inflammatory Bowel Disease Exacerbation With Interferon

The effects of IFN on IBD activity, perhaps the major concern underlying the reluctance to treat HCV in these patients, have been mixed. Currently still the mainstay of HCV therapy, IFN-α is a proinflammatory cytokine that stimulates a Th1-type immune response, similar to the immunologic milieu of CD.3 On the other hand, IFN-α has anti-inflammatory properties via regulation and down-modulation of Th2 cytokines, which are up-regulated in UC.4 Therefore, both theoretical assumptions of IBD

Discussion

In this study we present our experience with the treatment of hepatitis C in IBD patients, with emphasis on the risk of exacerbation of IBD during therapy with IFN, the safety profile of medications, and the efficacy of HCV therapy in this patient population. In addition, we review all available literature on this controversial topic.

In this retrospective cohort, therapy was overall well-tolerated, with only 1 patient experiencing a mild increase in baseline stool frequency, without gross

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    Conflicts of interest The authors disclose no conflicts.

    Funding Funding for this article was received from NIH DK-92336.

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