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DOI: 10.1055/s-0036-1584064
Decrease of Hyperferritinemia in chronic Hepatitis C patients due to IFN/RBV free antiviral treatment
Background: Elevated serum ferritin levels are common in patients with chronic HCV patient with advanced liver fibrosis and predictive for poorer response to treatment with pegylated interferon (PEG) and ribavirin (RBV). The aim of this study was to determine the effect of IFN/RBV free direct acting antiviral therapy on serum ferritin during and after antiviral treatment. In addition the association of serum ferritin with liver fibrosis was evaluated.
Methods: 97 patients with chronic hepatitis C (median age: 56a (34 – 77) male: 83.6%) treated with interferon free DAA regimens (sovaldi combined either with daclatasvir n = 16, simeprevir n = 12, ledipasvir n = 21, or the combination of ombitasvir/paritaprevir/ritonavir/dasabuvir n = 6; were evaluated. Laboratory tests were obtained at baseline, every 4 weeks during treatment, at the end of treatment, and after 12 weeks of treatment free follow up. Cirrhosis was defined as ≥12,5 kPa by transient elastography (Fibroscan®).
Results: 55/97 patients (56.7%, baseline (BL) HCV RNA log(6.22) IU/ml, Ø BL serum ferritin 667.4 µg/l ± 338.3, Cirrhosis n = 40 (72.7%), Ø FS 18,9 kPa ± 11.4, GT1a/1b n = 25/26; GT3a n = 3; GT4 n = 1; SVR12 n = 54, 98.1%) presented with elevated serum ferritin (> 400 µg/l in men, > 150 µg/l in women aged between 19 – 50a, 30 – 400 µg/l in women > 50a) at BL. No patient was C282Y homozygous or C282Y/H63D compound heterozygous. Ferritin levels decreased in all patients after treatment (patients with increased ferritin: BL: 667.4 µg/l ± 338.3, end of treatment (EOT): 259.2 µg/dl ± 150.9, p < 0.01; patients with normal ferritin levels: n = 42, BL: 171.1 µg/l ± 90.7; EOT: 91.3 µg/l ± 61.0, p < 0.01). N = 50 (90.9%) patients with elevated BL ferritin normalized at SVR. BL ferritin correlated with BL HCV RNA (p = 0.02, r = 0.87), but not with liver stiffness (p = 0.14, r = 0.22) or age (p = 0.94, r = 0.12).
Conclusions: Rapid decrease in serum ferritin during IFN/RBV-free treatment may reflect rapid regression of inflammation after inhibition of viral replication.