Long-term follow-up of interferon monotherapy in 454 consecutive naive patients infected with hepatitis C virus: Multi-course interferon therapy may reduce the risk of hepatocellular carcinoma and increase survival

Objective. The long-term effects of multi-course interferon (IFN) monotherapy in patients infected with hepatitis C virus (HCV) are still unclear. Material and methods. To evaluate the effects of multi-course IFN on hepatocarcinogenesis and survival, a follow-up study was conducted comprising 454 consecutively recruited non-cirrhotic naive patients infected with HCV, who had received IFN monotherapy between 1987 and 1992. The median follow-up was 11.3 years. Results. A sustained response (SR) after the first IFN was achieved by 152 patients (33.5%) ( Group A). Of 302 patients (66.5%) with non-SR after the first IFN, 130 patients (28.6%) did not receive additional IFN ( Group B), and the remaining 172 patients (37.9%) received multi-course IFN monotherapy ( Group C). With regard to hepatocarcinogenesis and survival rates for liver-related deaths, Groups A and C both showed significantly better long-term clinical outcome than Group B ( p< 0.001; log-rank test). Three independent factors were identified by multivariate analyses ( fibrosis stage 3, Group B, and age >= 50) for all patients and two factors ( fibrosis stage 3 and age >= 50) for Group C associated with hepatocarcinogenesis. With regard to hepatocarcinogenesis rates according to the mean alanine aminotransferase (ALAT) levels during the IFN-free period in Group C, significantly higher rates were noted in patients with ALAT levels above 1.5 x the upper normal limit (17.6%) than those below the limit (0%) ( p< 0.05). Conclusions. Multi-course IFN monotherapy reduces the risk of hepatocarcinogenesis and increases survival, and low ALAT levels during the IFN-free period are associated with lower hepatocarcinogenesis rates in multi-course IFN.