Changes in Growth Seen in Children on Peginterferon for Chronic HCV Infection

Megan Brooks

November 07, 2009

November 7, 2009 (Boston, Massachusetts) — During peginterferon alfa therapy, children and adolescents may experience significant changes in body weight, linear growth, and body composition. These effects seem largely reversible when therapy is stopped, although the effects on linear growth require longer term follow-up.

Principle investigator Maureen M. Jonas, MD, from the division of gastroenterology, hepatology, and nutrition at Children's Hospital, Boston, Massachusetts, reported the findings here at the Liver Meeting 2009, the 60th annual meeting of the American Association for the Study of Liver Diseases.

"We've seen for a while that patients on this therapy lose weight, but what is the significance of that?" Dr. Jonas said in an interview with Medscape Gastroenterology.

To investigate, Dr. Jonas and colleagues studied 111 children with chronic hepatitis C who were treated with peginterferon alfa-2 (180 μg/1.73 m2 weekly) with or without ribavirin (15 mg/kg/day) for 24 weeks (nonresponders) or 48 weeks. The children ranged in age from 5 to 16 years (mean age, 9.8 years).

The investigators analyzed changes in weight, height, and body mass index (BMI) z-scores after treatment and used dual-energy X-ray absorptiometry to characterize changes in body composition at the same time points.

"The children lost a significant amount of weight on therapy," Dr. Jonas told Medscape Gastroenterology. "They slowed their growth, their BMI z-scores went down, and it looks like, although we don't have all the data yet, that they actually lost fat rather than lean body mass, which might be a good thing."

More specifically, at baseline, mean weight, height, and BMI z-scores were 0.27, 0.58, and 0.52, respectively. On therapy, weight for age z-scores declined by 0.31 units after 24 weeks on peginterferon and by 0.44 units after 48 weeks (P < .0001 for both). Height for age z-scores declined by 0.20 units after 24 weeks (P = .0004) and by 0.35 units after 48 weeks (P < .0001). BMI z-scores declined by 0.24 units after 24 weeks on therapy (P = .0191) and by 0.33 units after 48 weeks (P = .0018).

Dual-energy X-ray absorptiometry analysis showed that percentage body fat declined by 0.48% after 24 weeks on peginterferon (P = .06) and 0.93% after 48 weeks (P = .006).

"Off therapy, the weight started to come back and sort of recovered, the BMI came back and recovered, but the height a year off treatment had not recovered," Dr. Jonas told Medscape Gastroenterology. Height z-scores remained 0.347 (P < .001) and 0.185 (P < .007) units lower than baseline at 24 and 48 weeks, respectively, off-therapy.

"We have later data points off-treatment, so we will be able to see if height does recover, only more slowly because it is height, or if it doesn't recover, which could have long-term ramifications in adolescents," Dr. Jonas said.

Estella Alonso, MD, from Northwestern University, Chicago, Illinois, who was not involved in the study said, "Looking at growth and body mass changes are important outcomes in that it might weigh into your decision about the timing of therapy for adolescents."

Dr. Jonas has disclosed that she has consulted for Gilead, Novartis, and Roche and has received grant/research support from Gilead and Bristol Myers Squibb. Dr. Alonso has disclosed no relevant financial relationships.

The Liver Meeting 2009: American Association for the Study of Liver Diseases 60th Annual Meeting: Abstract 708. Presented November 1, 2009.

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