Patients with hepatitis C and IR can develop a resistance to antiviral therapy, as well as fibrosis, steatosis, hepatocellular carcinoma.
Imran Khan, MD
Both insulin resistance (IR) and type 2 diabetes mellitus (T2DM) are more prevalent in patients with chronic hepatitis C virus (HCV) infection compared with the general population. In addition, patients with HCV and IR or T2DM often develop complications of HCV and tend to suffer adverse outcomes.
“Recent studies show that patients having both HCV and IR can develop fibrosis, steatosis, hepatocellular carcinoma (HCC) and resistance to antiviral treatment,” wrote Imran Khan, MD, a gastroenterologist at Ali Hospital in Lahore, Pakistan.
Some research has demonstrated that treating IR in patients with HCV could lead to better outcomes. Unfortunately, current data regarding the potential benefit of treating IR as a standard part of HCV therapy is lacking.
Khan and several of his colleagues at King Edward Medical University in Lahore recently set out to study the impact of 2 diabetic medications, metformin and pioglitazone, in combination with standard HCV treatment on the achievement of sustained virological response (SVR) in patients with chronic HCV.
The primary endpoint of the study by Khan and colleagues was the achievement of SVR in patients with HCV and IR. Patients included in the study were adults aged 18 to 65 years who tested positive for HCV genotype 3 and met the criteria for IR. Patients were excluded from the study if they were pregnant or lactating, or if they had cancer, renal dysfunction, or decompensated liver disease.
There were 138 patients (70 males and 68 females) included in this study, and they were divided equally into 3 treatment groups. All patients received the standard HCV treatment in Pakistan, which is combination therapy with peginterferon alfa-2a and ribavirin. Patients in group A only received treatment for HCV.
In addition to HCV treatment, patients in group B also received metformin 850 mg twice daily, while patients in group C also received pioglitazone 15 mg twice daily. Patients in all 3 groups received study medications for 24 weeks.
“At week 24, the group A score was normal (<100) in 28 (60.9%) patients and above normal in 18 (39.1%) patients. In group B, the score was normal (<100) in 39 (84.8%) patients and above normal in 7 (15.2%) patients. In group C, the score was normal (<100) in 31 (67.4%) patients and above normal in 15 (32.6%) patients.
Based on the results of this study, Khan and colleagues concluded that a greater number of patients receiving standard HCV treatment in combination with metformin achieved SVR when compared with standard HCV treatment alone or in combination with pioglitazone.
As this is one of the first studies to demonstrate the benefit of treating HCV-positive patients who also have IR with both standard HCV therapy and metformin to achieve SVR, more studies are needed to confirm the results and help determine a standard regimen for patients with HCV and IR, researchers noted.
The study, "Comparison of metformin and pioglitazone in achieving sustained virological response in chronic hepatitis C patients with insulin resistance: A quasi-experimental study," was published online in the Journal of Pakistan Medical Association last month.
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