ABSTRACT

Aim: To determine the improvement of Sustained Virological Response by adding Metformin in regular therapy, interferon and Ribavarin as compared to combination therapy alone in chronic hepatitis C patients with Insulin resistance (IR)

Methods: Total 148 cases of PCR carried out for diagnosis of hepatitis “C” infection and HOMA-IR with a cut of point >2.5 were enrolled in the study from out-patient department of Mayo hospital, Lahore, Pakistan. Patients with HOMA-IR >2.5 were given metformin 850mg twice daily for one week. If HOMA-IR did not decrease by 50% then metformin 1000mg twice daily would be given for another one week to see the response. Patients with 50% decrease in HOMA-IR, with Metformin therapy were included in the study and respective dose of metformin was continued for the period of study. Patients were then divided in two groups, group “A” and group “B” by simple random sampling method; Group A patients were treated with standard therapy and Group B: were treated with metformin and standard therapy. All patients with detectable HCV-RNA genotype 3 by PCR, insulin resistance (>2.5) determined by HOMA-IR and fasting blood sugar < 100mg/dl were included in study. Patient diagnosed with malignancy, renal dysfunction, under treatment with immunosuppressive therapy, any stigmata of de-compensated liver disease, diabetes mellitus type II or taking any anti diabetic therapy and pregnancy or breast feeding mothers were excluded from study. Sustained virological response was defined as undetectable serum HCV-RNA level (<50IU/ml) after 24 weeks of treatment by qualitative polymerase chain reaction method.

Results: This study included 148 patients. The range of patients age was 25 to 70 years old with average age of 48.51 11.25 years, Out of 148 patients, 83(56.08%) were males while 65 (43.92%) were female, thus both treatment groups had more male cases than female also showed insignificant difference between treatment groups and age distribution as well as clinical characteristics of patient as p-value > 0.05. HOMA-IR score showed statistically insignificant difference among both treatment group at baseline (P-value > 0.05). The mean value of the SVR was significantly improved in metformin added standard therapy group at 24th and 48th week as compared to standard therapy group. In terms of difference, two treatment groups in polymerase chain reaction were statistically significant as (P-value <0.05) at 12th and 48th while at 24th week. Conclusion: The standard combination therapy in patients of chronic hepatitis C with insulin resistance due to inclusion of Metformin results in improvement in SVR as compared to standard therapy alone

Keywords: HCV hepatitis C virus (HCV), Insulin resistance (IR), polymerase chain reaction (PCR), homeostasis model assessment (HOMA-IR) score, sustained virological response (SVR.