Interferon Treatment Challenges in Hepatology - Gastroenterology and Hepatology

The treatment process with interferons?

Hello: After failing treatment with nucleos(t)ide analogs (for a year and a half), my e-antigen remains positive.
After two years of follow-up treatment, I finally qualified for long-acting interferon therapy covered by health insurance.
After receiving two doses, my GPT and GOT levels skyrocketed (from 200 and 310 before treatment to 400 and 810 after two doses).
The doctor mentioned that the reaction was too severe and expressed concern for my safety, advising me to pause treatment for a week and then return for blood tests to check if the levels decrease.
However, won't stopping the interferon treatment negatively impact its effectiveness? Why did I have such a strong reaction, especially since I experienced almost no side effects (the first dose had more noticeable side effects, while the second dose had almost none)? If interferon treatment is not effective, are there other treatment options available? Will I be able to complete the entire interferon treatment course (24 weeks)? Regards.

you dian shi wang, 20~29 year old female. Ask Date: 2006/03/03

Dr. Xu Jinchuan reply Gastroenterology and Hepatology

Hello! Due to significant reactions, it is indeed important to proceed with caution.
Temporarily pausing treatment to monitor changes in the condition is crucial.
If the interruption is not prolonged, the effectiveness will not be affected.
However, if the physician carefully assesses that treatment cannot continue, it will revert to the original state.
Therefore, whether you can complete the 24 weeks of treatment will require further evaluation.
Does the physician have any recommendations for rehabilitation?

Reply Date: 2006/03/03

More Info

Hello! Thank you for your question regarding the challenges associated with interferon treatment in hepatology, particularly in the context of hepatitis B virus (HBV) infection.
Interferon therapy, particularly pegylated interferon, has been a cornerstone in the treatment of chronic hepatitis B and C. It works by enhancing the immune response against the virus and has been shown to lead to sustained virological responses in some patients. However, it is not without its challenges and potential side effects.
From your description, it seems that you have experienced a significant increase in liver enzymes (GPT and GOT) following the initiation of interferon therapy. This is not uncommon, as interferon can sometimes provoke an immune response that leads to a temporary exacerbation of liver inflammation. The fact that your physician has advised you to pause treatment for a week to monitor your liver function is a prudent approach. It is essential to ensure that the liver is not under excessive stress, as this could lead to further complications, including acute liver failure.

You are correct in your concern that interrupting interferon therapy might affect the overall treatment outcome. However, it is crucial to balance the potential benefits of continuing treatment against the risks of exacerbating liver damage. If your liver enzymes remain elevated after the pause, your physician may consider adjusting the treatment plan, which could include reducing the dose of interferon or switching to a different antiviral therapy.

In terms of alternative treatments, if interferon is not effective or tolerated, there are several other antiviral medications available for managing chronic hepatitis B. Nucleos(t)ide analogs such as entecavir and tenofovir are highly effective and have a favorable safety profile. These medications work by directly inhibiting the replication of the virus, which can lead to a reduction in liver inflammation and improvement in liver function over time.

Regarding your question about completing the full course of interferon treatment, it is essential to have open communication with your healthcare provider. They will monitor your liver function closely and make recommendations based on your individual response to treatment. If the side effects or liver enzyme elevations become too concerning, they may suggest transitioning to a different treatment modality.

In summary, while interferon therapy can be effective, it is not without risks, and individual responses can vary significantly. Close monitoring and collaboration with your healthcare team are crucial in navigating these challenges. If interferon therapy proves to be ineffective or too risky, there are alternative antiviral treatments available that can help manage your hepatitis B infection effectively. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.
Best wishes for your health and treatment journey!

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