The findings come from a new look at more than 3,000 patients with liver damage caused by hepatitis C infection. Each received one of 10 different treatment strategies in four multi-center clinical trials. In a report to the annual meeting of the American Association for the Study of Liver Diseases, a team of researchers from France and the U.S. reports that the most effective treatment improves fibrosis -- scar tissue -- in nearly three out of four patients. And nearly half of those with cirrhosis, a more severe stage of disease, showed improvement.
"Previously we thought fibrosis and cirrhosis was irreversible -- that was the standard dogma," study co-author John McHutchison, MD, tells WebMD. "When you look at a large enough group of patients you see there is the opportunity to prevent fibrosis and an opportunity for regression of fibrosis."
Patients were more likely to see their liver damage improve if they were treated with the new "pegylated" form of interferon combined with the antiviral drug ribavirin. Pegylation is a chemical change that makes interferon work much better. It also makes it last much longer, so that patients only need one shot a week instead of daily treatment. Still, treatment is no picnic: the side effects make most people feel like they have a bad case of the flu. Treatment lasts for a year.
Is it worth it? Many patients see their hepatitis infection disappear -- and long-term studies suggest that it rarely comes back. Even if the virus doesn't go away, the new study suggests that reversal of liver damage continues.
"If you look at patients five and 10 years after their first response to treatment, many of them still have a regression of their fibrosis," says McHutchison, a researcher at Scripps Clinic in La Jolla, Calif. "Some patients with significant cirrhosis have regressed over years. There seems to be continual improvement. The virus doesn't come back. The response is durable."
It seems to be the interferon -- particularly the pegylated form -- that helps the liver. But getting rid of HCV also helps, which seems to be why patients who got the pegylated interferon/ribavirin combination did the best.
"Pegylated interferon has an anti-fibrotic effect," Michael P. Manns, MD, tells WebMD. "Two to five percent of people with HCV infection develop liver cancer. Interferon-treated patients -- even if not cured -- have a lower rate of [developing this type of cancer]." Manns is director of the GI and liver departments at the University of Hannover, Germany.
Other factors that predicted successful treatment were being younger than 40 and not being overweight.
Trials now underway are exploring whether extending HCV treatment -- for up to four years -- can further reverse liver damage.