Abstract Summary
Systematic data assessing the treatment of patients with chronic hepatitis C under methadone maintenance are rare. In contrast, intravenous drug users represent the most relevant patient population with newly infected young individuals in the western world.
In a prospective study of 100 patients, 50 under methadone and 50 control patients were matched for sex, age, HCV genotype, and HCV RNA. In each group 44 patients were male, HCV genotype 1 or 4 were present in 29 patients (58%) and genotype 2 or 3 in 21 patients (42%). Median age was 35 years (methadone) and 40 years (control). The median HCV RNA was 556.000 IU/ml (methadone) and 708.000 IU/ml (control).

Treatment with PEG-Intron (pegylated interferon alfa-2b 1.5 mcg/kg qw) and ribavirin (800 - 1200 mg bid) lasted 6 (genotype 2, 3) or 12 months (genotype 1, 4). Median time on stable methadone maintenance was 21 months. At the end of treatment HCV RNA <600 IU/ml was reached in 21/43 methadone patients (49%) and in 32/45 (71%) controls (p=0.049, lost to follow up equals failure analysis).

Discontinuation due to non-compliance or side effects was 18/43 in methadone patients (42%) and 8/45 control patients (18%) (p=0.019). Laboratory markers (e.g. ALT, leukocytes, haemoglobin, platelets) were not different between methadone arm and control. No serious psychiatric adverse event occurred in either arm.

Conclusions: Pegylated interferon and ribavirin seem reasonably safe and sufficiently effective in patients on methadone maintenance. The lower efficacy in methadone patients is most probably due to a lower adherence. But the end of treatment result is still close to the results of the pivotal study which led to the approval of PEG-Intron and ribavirin combination therapy (Manns, Lancet 2001;358: 958-965).

03/28/03

Reference
S Mauss and others. IS TREATMENT OF CHRONIC HEPATITIS C IN PATIENTS UNDER METHADONE MAINTENANCE FEASIBLE? A PROSPECTIVE, CONTROLLED STUDY. Abstract 4124.00. Abstracts of the 38th Annual Meeting of the European Association of the Study of the Liver (EASL).

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