Dorota Zarebska-Michaluk

Publications (8)6.46 Total impact

• Article: [Efficacy of combined antiviral therapy with interferon alfa and ribavirin in chronic hepatitis C patients with extrahepatic manifestations].

  Dorota Zarebska-Michaluk, Dariusz Marek Lebensztejn, Wiesław Kryczka
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  ABSTRACT: The aim of the study was to assess the efficacy and safety of treatment with interferon alpha and ribavirin in patients with chronic hepatitis C and extrahepatic manifestations as well as to determine prognostic factors of therapy effectiveness. 179 consecutive naive patients with chronic hepatitis C treated with interferon alpha and ribavirin were studied. 120 patients (67%) presented extrahepatic manifestations. The most frequent were cryoglobulinaemia, thrombocytopenia and thyroid gland pathology. Efficacy of antiviral treatment was lower (SVR 33.3% vs. 52.5%, p=0.013) and frequency of adverse events higher in patients with chronic hepatitis C and extrahepatic manifestations in comparison to those without extrahepatic pathology. Younger age, shorter duration of HCV infection and less advanced liver fibrosis were prognostic factors of better response to antiviral therapy in group of patients with chronic hepatitis C and extrahepatic manifestations.
  Przegla̧d epidemiologiczny 02/2007; 61(3):551-8.
• Article: [Assessment of the usefulness of combination of selected clinical and demographic parameters in prediction of the severity of liver fibrosis in patients with chronic hepatitis C].

  Wiesław Kryczka, Magdalena Chrapek, Dorota Zarebska-Michaluk
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  ABSTRACT: To create a simple diagnostic index I for noninvasive distinguish between mild and significant liver fibrosis (stages 0-2 versus 3-6 according to Ishak's criteria) among patients with chronic hepatitis C (CHC). Consecutive interferon-naive 572 CHC patients (F/M: 246/326; median age: 43 years). The I index was created on the data from training group (341 patients diagnosed in 1995-2000 years) and its discriminative value was then assessed separately in training group, validation group (231 patients diagnosed in 2001-2003 years) and entire group using among other things the AUROC measure. The I index is based on information about patient's age, alcohol abuse, AST activity and platelet counts. The AUROC measures were 0.875 [95% CI (0.833-0.916)], 0.926 [95% CI (0.889-0.962)] and 0.890 [95% CI(0.860-0.921)] for training, validation and entire group, respectively. The I values corresponding to at least 95% of sensitivity (observed in about 40% of all patients) could excluded the stage 0-2 with accuracy close to 100%. Based on I values corresponding to at least 95% of specificity (observed in about 17% of all patients) the presence of stage 3-6 could be confirmed with accuracy of about 70%. The I index possesses the statistically significant ability to distinguish between mild and significant fibrosis and seems to be useful in monitoring of non-treated patient with mild fibrosis.
  Przegla̧d epidemiologiczny 02/2005; 59(2):395-403.
• Article: [Pegylated interferon-alfa 2a with ribavirin in chronic viral hepatitis C (final report)].

  Jacek Juszczyk, Barbara Baka-Cwierz, Marek Beniowski, Hanna Berak, Beata Bolewska, Anna Boroń-Kaczmarska, Janusz Cianciara, Andrzej Cieśla, Andrzej Dziambor, Jacek Gasiorowski, [......], Magdalena Sliwińska, Katarzyna Swietek, Krzysztof Tomasiewicz, Ewa Topczewska-Staubach, Hanna Trocha, Marek Wasilewski, Marta Wawrzynowicz-Syczewska, Witold Wrodycki, Dorota Zarebska-Michaluk, Małgorzata Zejc-Bajsarowicz
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  ABSTRACT: We evaluated the efficacy and safety of peginterferon alfa-2a [40KD] (Peg-IFNalpha-2a) plus ribavirin in patients with chronic hepatitis C in an open-label programme in a routine clinical setting in Poland. Patients received Peg-IFNalpha-2a 180mg/week plus ribavirin 800-1200 mg/d for 48 weeks. Sustained virological response (SVR) was defined as undetectable HCV RNA (<50IU/mL) at the end of follow-up (week 72). 466 adults were enrolled. Most patients (87.3%) had genotype 1 infection. 440 subjects (94,4%) completed treatment. The overall SVR rate was 55.7%. A higher SVR rate was obtained in treatment-naïve patients (58.7%) than in relapsers (47.8%; p=0,048). SVR rates in genotype 1 and non-1 patients were 51.1% and 88.5%, respectively (p<0.001). There were significant higher SVR rates in patients with lower baseline fibrosis (p=0,01). There were no differences in SVRs by gender or viral load. Hemoglobin, leukocyte and neutrophil levels decreased significantly during treatment, but returned to baseline after the end of treatment. ALT levels decreased significantly during treatment in patients with and without an SVR. 38.4% of patients experienced adverse events like neutropenia, anemia, thrombocytopenia, and other. There was one death (severe thrombocytopenia). CONCLUSIONS: The overall SVR achieved in this predominantly genotype 1 population was 55.7%. SVR rates were significantly higher in treatment-naïve patients, those with non-1 genotypes, and in patients with lower baseline fibrosis scores.
  Przegla̧d epidemiologiczny 01/2005; 59(3):651-60.
• Article: [The impact of coexisting diseases on the course of chronic hepatitis C].

  Wiesław Kryczka, Dorota Zarebska-Michaluk, Magdalena Chrapek
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  ABSTRACT: to investigate the relationship between coexisting diseases (CD) and the progress of liver disease in chronic hepatitis C (CHC). 557 consecutive pts (F/M: 262/295; median age: 42 years) with untreated CHC. CD were defined as a chronic diseases requiring treatment at least 12-months before liver biopsy. HBsAg- and/or HIV-positive as well as alcohol abusers and intravenous drug abusers were excluded from analysis. The significant progress of liver disease was described in the terms of advanced fibrosis (AF), defined as stage 3-6 according to Ishak's system. The relationship between CD and AF was assessed in multivariate analysis simultaneously taking into account the following variables: age, gender, route of transmission, liver steatosis and overweight. Multivariate analysis revealed that CD is independently associated with AF (adjusted OR = 3.4; p < 0.0001). Similar relationship is observed for age over 40 years as well as HCV infection as a result of medical procedures. The contraindications to antiviral treatment were observed in 18.7% pts with CD and only 1.1% pts without CD (p < 0.0001). Patients with CD are at relatively high risk of AF and simultaneously, notable part of them presents contraindications to antiviral treatment.
  Przegla̧d epidemiologiczny 01/2005; 59(2):405-10.
• Article: Treatment of acute hepatitis C.

  Wiesław Kryczka, Dorota Zarebska-Michaluk
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  ABSTRACT: We presented the results of treatment in patients with AHC and compared these findings with natural outcome of AHC in untreated patients. Ten treated AHC patients (5F/5M, mean age: 35.5 yrs; all HCV-RNA-positive including 9 anti-HCV-positive). Antiviral treatment was started within 3 to 18 (median 9) weeks after the onset of acute hepatitis including eight patients with monotherapy of IFN and two patients with combined (IFN + ribavirin) therapy. Fifty consecutive untreated AHC patients (26F/24M, mean age: 40.8 yrs; all HCV-RNA-positive, including 29 anti-HCV-positive) without contraindications to treatment with IFN. Only one treated patient presented no response and the other 9 patients presented rapid normalization of serum ALT levels in 4th-6th week of the therapy. In two patients, ALT increased in the course of therapy and after adding ribavirin the treatment was continued up to 48 weeks in total. At the end of treatment point, nine patients showed biochemical and virological response, but one relapsed both in biochemical and virological respect and virological relapse was observed in another one. Finally, sustained response was observed in 7 of 10 (70%) of treated compared with 22 of 50 (44%) untreated patients (p = n.s.). The beneficial effect of antiviral treatment was observed among patients with early anti-HCV seroconversion: 7 of 9 treated patients recovered persistently compared with 8 of 29 untreated (p = 0.021). The antiviral therapy in AHC seems to be effective and should be widely used, especially for individuals with early anti-HCV seroconversion. Ribavirin seems to be helpful for patients, who have not responded to interferon monotherapy.
  Medical science monitor: international medical journal of experimental and clinical research 09/2003; 9 Suppl 3:22-4. · 1.70 Impact Factor
• Article: Progress of liver disease in chronic hepatitis C patients who failed antiviral therapy.

  Wiesław Kryczka, Magdalena Chrapek, Katarzyna Paluch, Dorota Zarebska-Michaluk
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  ABSTRACT: The natural history of chronic hepatitis C (CHC) is characterized by gradual progression of hepatic fibrosis, which can lead to cirrhosis. The aim of our study is to examine the influence of ineffective antiviral therapy on progress of the liver disease in CHC patients. Seventy-seven treated and non-treated CHC patients with two liver biopsies: baseline (BLB) and control (CLB) performed at least 12 months after treatment and at least 18 months from BLB in non-treated patients were studied. Twenty-eight CHC patients (age: 40.3 +/- 9.2 yrs; 22M), non-responding to interferon therapy (all with pretreatment fibrosis), were compared with non-treated patients divided into subgroups NT1 (21 patients [age: 45.1 +/- 11.2 yrs; 10M] with fibrosis in BLB) and NT2 (28 patients [age: 34.7 +/- 12.6; 17M] without fibrosis in BLB). The baseline clinical data between study groups as well as activity grade and fibrosis staging scores of the paired biopsy samples were compared. All three groups were comparable in terms of mean duration of the disease and interval between biopsies. There were no significant differences of clinical features in T and NT1 groups. In CLB, the patients from NT1 group presented non-significant worsening of staging and grading and in NT2 group a slight but statistically significant increase in grading was observed. In contrast, the treated patients had a slight, but significant improvement in liver histology. Antiviral treatment stopped the progression of liver disease in CHC despite the lack of biochemical and virological response. In non-treated patients a slight tendency to worsening of morphological parameters was observed.
  Medical science monitor: international medical journal of experimental and clinical research 09/2003; 9 Suppl 3:25-8. · 1.70 Impact Factor
• Article: Assessment of selected clinical factors as predictors of response to combined interferon-alpha plus ribavirin therapy among patients with chronic hepatitis C.

  Wiesław Kryczka, Dorota Zarebska-Michaluk, Magdalena Chrapek
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  ABSTRACT: Combined interferon-alpha (IFN) plus ribavirin therapy is recommended as first-line regimen treatment of chronic hepatitis C (CHC) patients. The aim of the study was to evaluate the selected clinical factors in the prediction of response to IFN with ribavirin for initial therapy and retreatment of CHC. Ninety eight consecutive CHC patients who completed the combined IFN with ribavirin therapy (24 or 48 weeks), including 79 naive patients (age: 41.0 +/- 10.9 yrs; 51M; NAIVE group) and 19 nonsustained responders to prior IFN monotherapy (age: 40.8 +/- 10.2 yrs; 10M; RETHERAPY group). Sustained Response (SR) was defined as persistent normalization of ALT and loss of serum HCV-RNA 6 months after the end of treatment; all other patients were defined as nonresponders (NR). Age, gender, pretreatment histology (assessed according to Ishak's scoring system) and baseline ALT, gamma-GTP and iron serum levels were compared in SR and NR patients, separately in NAIVE and RETHERAPY groups. The baseline clinical characteristics of NAIVE and RETHERAPY group did not differ significantly. 28 of 79 (35.4%) NAIVE patients and 9 of 19 (47.4%) RE-THERAPY patients achieved SR to the therapy. NAIVE sustained responders presented significantly lower staging scores and gamma-GTP levels in comparison with nonresponders. Multivariate logistic regression analysis showed that only fibrotic score lower than 3 was independently (p = 0.04) associated with SR. In RETHERAPY group, only female gender was positively correlated with SR. The other analyzed parameters did not significantly differ between responders and nonresponders. The results of the present study suggest that sustained response to combined therapy in naive CHC patients is associated with absence or minimal hepatic fibrosis prior to the therapy. Among retherapy patients, females are more likely to achieve sustained response, irrespective of fibrosis stage.
  Medical science monitor: international medical journal of experimental and clinical research 09/2003; 9 Suppl 3:32-5. · 1.70 Impact Factor
• Article: [Rate of liver fibrosis progression among patients with chronic hepatitis C in Poland].

  Wiesław Kryczka, Magdalena Chrapek, Katarzyna Paluch, Dorota Zarebska-Michaluk, Antoinette Urbaniak
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  ABSTRACT: To assess the rate of liver fibrosis (RLF) among previously untreated patients with chronic hepatitis C (CHC) and to identify predictors of rapid progression to cirrhosis in this group. Medical records of 337 consecutive patients with biopsy proven CHC (anti-HCV and HCVRNA positive; F/M: 153/184; mean age at biopsy: 43 +/- 14 years) and with known probable age at infection have been analysed. There were no intravenous drug users among the patients. HBsAg--and HIV-positive subjects as well as those with other concomitant liver disease were excluded from the analysis. The RLF was defined as the ratio between fibrosis stage (scored 0-6 units [U] according to Ishak's criteria, with 6 representing established cirrhosis) and the duration of HCV infection (in years). The RLF was analysed in relation to the age at infection, sex, route of transmission, alcohol abuse, past HBV infection, acute hepatitis history, HCV genotype and hepatic steatosis. Based on published data, a patient with RLF > or = 0.3 U/yr (cirrhosis up to 20 years after HCV infection) was arbitrarily defined as a rapid progressor. Both uni- and multivariate statistical analyses were performed. The mean RLF was 0.14 +/- 0.17 U/yr (range 0-0.83) and the expected mean duration from infection to cirrhosis was 43 years. In multivariate analysis the only independent factors associated with an increase in RLF were the older age at infection and alcohol abuse (both with p < 0.0001). 58 [17.2%] patients were rapid progressors and the same factors as mentioned above have been independent predictors of cirrhosis up to 20 years after infection. There were as much as 55.5% of rapid progressors among alcohol abusers infected in the age over 30 and only 1.9% among non-alcoholic patients infected in the age up to 30 years. Our study showed that natural course of CHC in Poland is similar to other regions of the world. HCV-related liver disease progression is accelerated among alcohol abusers and infected in older age. In contrast, risk of cirrhosis seems to be minimal among non-alcoholic patients infected before the age of 30.
  Polskie archiwum medycyny wewnȩtrznej 08/2003; 110(2):869-75. · 1.37 Impact Factor