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Video: When Pediatricians Saw The Results Of This Therapy In Adults, They Could Only Envy
When pediatricians saw the results of this therapy in adults, they could only envy
A direct antiviral drug for the treatment of hepatitis C in children over 12 years old has been registered in Russia. This means that the innovative therapy that has saved hundreds of thousands of adults around the world is now available for adolescents. Why it can be considered a revolution, and how they will be treated up to 12 years, said the head. Department of the Clinic of the Federal Research Center of Nutrition and Biotechnology Tatiana Strokova.
/ FOTODOM /
In Russia, a direct antiviral drug has been registered for the treatment of chronic hepatitis C in children over 12 years of age. This means that the innovative therapy that has saved hundreds of thousands of adults around the world is now available for adolescents. Why this can be considered a revolution, and how children under 12 years old will be treated, the head of Mednovosti told. Department of Pediatric Gastroenterology, Hepatology and Dietetics of the Clinic of the Federal State Budgetary Scientific Institution "Federal Research Center of Nutrition and Biotechnology", Head. Department of Dietetics and Nutritionology, Russian National Research Medical University named after N.I. Pirogova, professor Tatiana Strokova.
Tatyana Viktorovna, are we really seeing a revolution in the treatment of children?
- Until February 2019, the only approved treatment for hepatitis C in children and adolescents in Russia was regimens with the inclusion of interferon preparations. Interferon-free therapy for hepatitis C for adults appeared in the world and in our country several years ago. And, indeed, it revolutionized treatment. When our colleagues working with adult patients began to demonstrate the results of antiviral therapy, the effectiveness of which was close to 100%, pediatricians could only envy.
As I already said, interferon preparations were previously used in the form of mono- or combination therapy with other antiviral drugs. Unfortunately, the treatment was long - from 6 to 12 months, not always effective and causing a wide range of side effects. In our practice, we were often forced to reduce the dose of interferons due to the severity of side effects, and several children even had to completely cancel therapy.
But in any case, 100% of children experienced myalgia and flu-like syndrome with high fever. For the majority, this passed after 3-4 injections of pegylated interferon, but in some children, hyperthermia persisted throughout the entire period of treatment. We recorded changes in the cardiovascular system, decreased appetite, growth retardation, vomiting, changes in the blood (leukopenia, thrombocytopenia).
As for the direct antiviral drug, in the course of the international multicenter study, which was conducted before its registration in Russia, there was not a single case of adverse events that required the cancellation of therapy. Treatment with direct antiviral drugs lasts only 8, maximum 16 weeks and is well tolerated by patients. Studies have confirmed the high efficiency of the drug, comparable to the results of treatment in adult patients. All data analyzed and published.
New therapy included in the CHI program?
- Not yet, but we very much hope that this will happen. In my opinion, if drugs of direct antiviral action are available, all children should be treated with them, regardless of the severity of the disease. Unfortunately, so far many children are not treated at all. As far as I know, in several regions of the country, the treatment of our patients at the expense of budget funds will begin in 2020.
This all applies to children over 12 years old. And what are the prospects for those who are less?
- Until now, the second stage of research on antiviral therapy in children of the younger age group is underway. More than ten international centers, including Russian ones, take part in the study. There are some nuances that take time. I have no doubt that we will get good results here too. Before receiving permission to use drugs under 12 years old, all children must be registered with dispensaries, undergo regular examinations and, if necessary, receive supportive therapy, including a diet. It is very important to monitor the condition of the child as a whole, since the treatment of concomitant pathology sweeps the progression of hepatitis.
How do children get hepatitis C?
- We have been maintaining a local register since 1996 and we see that the number of parenteral cases of transmission of infection (through blood - during transfusion or during surgery) has sharply decreased. It should be noted that infected children are absolutely not dangerous for their classmates, but due to the low awareness of society, their social maladjustment is taking place. Many parents ask not to report the diagnosis to school because children become outcasts in the classroom.
If we talk about the real danger, then today perinatal infection comes to the fore - the transmission of the virus from the mother to the fetus. The most unpleasant thing is that grown-up children whom we have not been able to cure, or whose parents have refused therapy, can transmit the infection to future generations. With an unfavorable course of pregnancy, when the placental barriers are reduced, the risk of infection of the fetus is very high. Data about a pregnant woman diagnosed with hepatitis C is transferred to the pediatric network so that the baby is followed up from the moment of birth. Fortunately, within 18-24 months in half of children, the virus eliminates itself. Therefore, before the age of three, the child is not prescribed antiviral treatment at all.
The complexity of timely diagnosis also lies in the fact that the icteric form of the disease develops only in 2% of cases. And the virus is detected, as a rule, only when the child is examined for another reason. For example, in preparation for the removal of tonsils or adenoids. Fortunately, in pediatric practice, we find fewer severe manifestations of the disease, only about 2-4% develop cirrhosis of the liver. In our practice, there were several children whose disease was aggressive from the very beginning.
What is the scale of the problem?
- Around the world there are about 16 million children with hepatitis C, which is 8 times more than those with HIV. According to the Rospotrebnadzor register, there are 17,000 such children in Russia, but in reality there are still less of them. The fact is that often chronic hepatitis C is diagnosed by the presence of antibodies without a more detailed examination, but this is wrong. We often see children with an "established" diagnosis, but the diagnosis of chronic hepatitis C is not confirmed. In another 10-20% of cases, spontaneous elimination of the virus is observed (treatment should be prescribed only after a second examination 6 months after the initial detection of hepatitis virus markers and signs of its activity).
About 500 new cases of the disease are registered in Russia every year. But it is difficult to reliably estimate the prevalence of the infection: there are regions in which the detection of the disease is low
And how can you make it better?
- The number of patients in our country has increased sharply when it became mandatory to conduct research on hepatitis C, B, RW, HIV before, for example, surgery. Of course, a more systematic approach is needed. Ideally, this is screening in high-risk groups that are contributing to the increase in infection. With regard to children, there should be good supervision of infants born to mothers with hepatitis C infection. It would be good to use the mass medical examination, which all children undergo at the age of 7 in front of school. The next very important period for large-scale clinical examination is 12 years old, when adolescents no longer have childish temptations. Moreover, for patients of this age there is already an approved and effective drug.