Abstract
Traditional Chinese herbal therapies are widely used for the treatment of chronic hepatitis C (CHC) in China and several Asian countries. The aim of this study was to perform a meta-analysis of randomized controlled trials (RCTs) comparing peginterferon therapy with peginterferon plus Chinese herbal therapy for the treatment of CHC. The Cochrane Central Register of Controlled Trials, Medline, Science Citation Index, EMBASE, China National Knowledge Infrastructure, Wanfang Database, and China Biomedical Database were searched to identify RCTs that evaluated the virological response of CHC patients to peginterferon therapy and peginterferon plus Chinese herbal therapy. We statistically combined data using a fixed-effects meta-analysis according to the intention-to-treat principle. The literature search yielded 905 studies and nine RCTs composed of 858 patients matched the selection criteria. Overall, sustained virological response (SVR) was significantly higher in patients treated with peginterferon plus Chinese herbs than in patients treated with peginterferon alone (81 % vs. 64 %, respectively; odds ratio, 2.60; 95 % confidence interval: 1.32–5.14; p < 0.05). A combined therapy of peginterferon plus Chinese herbs was also superior to peginterferon therapy in achieving an early viral response (EVR, 80 % vs. 70 %, respectively), a viral response at week 24 of treatment (82 % vs. 73 %, respectively), and end-of-treatment viral response (ETVR, 73 % vs. 62 %, respectively). The combined therapy resulted in fewer relapses, fewer adverse events, and more rapid alanine transaminase normalization; however, both treatments yielded a similar rapid viral response (RVR, 53 % vs. 57 %, respectively). The current evidence suggests that combined therapy of peginterferon plus Chinese herbs yields a higher viral response and results in fewer relapses and fewer adverse events than peginterferon therapy alone.
Similar content being viewed by others
References
Khuroo MS, Khuroo MS, Dahab ST (2004) Meta-analysis: a randomized trial of peginterferon plus ribavirin for the initial treatment of chronic hepatitis C genotype 4. Aliment Pharmacol Ther 20:931–938
Hoofnagle JH (1997) Hepatitis C: the clinical spectrum of disease. Hepatology 26(3 Suppl 1):15S–20S
Anonymous (1999) EASL International Consensus Conference on Hepatitis C. Paris, 26–28, February 1999, Consensus Statement. European Association for the Study of the Liver. J Hepatol 30:956–961
Lauer GM, Walker BD (2001) Hepatitis C virus infection. N Engl J Med 345:41–52
Chinese Society of Hepatology and Chinese Society of Lemology and Parasitology (2004) Guideline for prevention and treatment of hepatitis C in China. Zhonghua Yi Xue Za Zhi 84:775–780
Manns MP, McHutchison JG, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, Goodman ZD, Koury K, Ling M, Albrecht JK (2001) Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 358:958–965
Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Gonçales FL Jr, Häussinger D, Diago M, Carosi G, Dhumeaux D, Craxi A, Lin A, Hoffman J, Yu J (2002) Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 347:975–982
Hadziyannis SJ, Sette H Jr, Morgan TR, Balan V, Diago M, Marcellin P, Ramadori G, Bodenheimer H Jr, Bernstein D, Rizzetto M, Zeuzem S, Pockros PJ, Lin A, Ackrill AM; PEGASYS International Study Group (2004) Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med 140:346–355
Zhao S, Liu E, Wei K, Wang Y, Li Y, Huang B, Chen Y, Yang P (2011) Treatment with peginterferon versus interferon in Chinese patients with chronic hepatitis C. Eur J Clin Microbiol Infect Dis 30:51–57
Falck-Ytter Y, Kale H, Mullen KD, Sarbah SA, Sorescu L, McCullough AJ (2002) Surprisingly small effect of antiviral treatment in patients with hepatitis C. Ann Intern Med 136:288–292
Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH (2000) Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med 132:296–305
Zhao S, Liu E, Wei K, Lu S, Chu Y, Li Y, Wang Y, Huang B, Chen Y, Yang P (2011) Interferon plus Chinese herbs are associated with higher sustained virological response than interferon alone in chronic Hepatitis C: a meta-analysis of randomised trials. Antiviral Res 89:156–164
Saydah SH, Eberhardt MS (2006) Use of complementary and alternative medicine among adults with chronic diseases: United States 2002. J Altern Complement Med 12:805–812
Fu M, Gu X, Zhu Y (2013) Combination of Chinese traditional and western medicine in treating 32 patients with chronic hepatitis C (In Chinese). Chin J Integr Tradit West Med Liver Dis 23:4–6
Ji X, Gu X, Fu M (2012) Combination of Chinese traditional and western medicine in treating patients with chronic hepatitis C (In Chinese). Jiangsu J Tradit Chin 44:30–31
Jing X, Qi P, Zhang Y, Dong J, Li Y, Dong X, Pei Q (2010) Clinical observation of combined Chinese medicine and pegylated interferon α-2 a in treating chronic hepatitis C (In Chinese). Shanghai J Tradit Chin Med 44:36–38
Nie H, Chen J, Wang C, Ling Q, Wang R, Chen Y, Dong H (2012) A prospective study on Fuzhengjiedu prescription combined with standard treatment program for patients with genotype 1 chronic hepatitis C (In Chinese). Infect Dis Inf 25:170–173
Qiu R, Wang X, He X, Ye X, Lin G, Huang Q, Hu Z, Huang X (2012) Clinical study on treating chronic hepatitis C with the cogongrass rhizome decoction combined with interferon and ribavirin (In Chinese). Clin J Chin Med 4:5–8
Sun Y (2005) Anti-HCV particles combined with pegylated interferon plus ribavirin in the treatment of chronic hepatitis curative effect observation (in Chinese). Unpublished master’s thesis, Shandong University of Traditional Chinese Medicine, Jinan, China
Wang X, Yang A, Zeng F, Yu J (2012) Combination of Chinese traditional and western medicine in treating patients with chronic hepatitis C (in Chinese). J Guangxi Univ Chin Med 15:7–9
Xie M, Gao O, Tan X (2013) Clinical study of treatment of 84 chronic hepatitis C patients with Peginterferon, Ribavirin and Jiedushengbai Granula (in Chinese). China Mod Med 20:124–126
Zhang F (2009) Traditional Chinese medicine and western medicine combined therapy for 30 cases of chronic hepatitis C (in Chinese). Tradit Chin Med Res 22:27–28
Iafolla M (2002) Pegasys: FDA approved Pegasys (peginterferon alfa-2a) for the treatment of hepatitis C. Sidahora 4:8–10
Guideline on Hepatitis C - European Medicines Agency. Available online at: http://www.ema.europa.eu/ema/pages/includes/document/open_document.jsp?webContentId=WC500003461
Wang BE (2000) Management of chronic hepatitis B: treatment of chronic liver diseases with traditional Chinese medicine. J Gastroenterol Hepatol 15(Suppl):E67–E70
Fried MW, Hadziyannis SJ, Shiffman ML, Messinger D, Zeuzem S (2011) Rapid virological response is the most important predictor of sustained virological response across genotypes in patients with chronic hepatitis C virus infection. J Hepatol 55:69–75
Yu JW, Wang GQ, Sun LJ, Li XG, Li SC (2007) Predictive value of rapid virological response and early virological response on sustained virological response in HCV patients treated with pegylated interferon alpha-2a and ribavirin. J Gastroenterol Hepatol 22:832–836
Zhao SH, Chu YL, Cheng DX, Waqar AB, Yu Q, Yang PH, Xue X, Yang HJ, Liu EQ (2009) Treatment with peginterferon plus ribavirin vs. interferon plus ribavirin for 48 weeks in Chinese patients with chronic hepatitis C. Int J Clin Pract 63:1334–1339
Acknowledgments
This work was partly supported by the Fundamental Research Funds for the Central Universities, the China Postdoctoral Science Foundation (201104669), the National Natural Science Foundation of China (81070250 and 81270348), the National Science and Technology Support Program (2012BAI39B02), and a Public Service Platform Grant and Science Foundation of Shaanxi Province (2010FWPT-15, 2012FWPT-03, 2012KJXX-07).
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cheng, D., Liu, E., Li, Y. et al. Peginterferon plus Chinese herbal therapy is associated with a higher virological response than only peginterferon therapy in chronic hepatitis C. Eur J Clin Microbiol Infect Dis 33, 433–438 (2014). https://doi.org/10.1007/s10096-013-1973-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-013-1973-y