2014, Number 5
<< Back Next >>
Ann Hepatol 2014; 13 (5)
Treatment of chronic hepatitis C genotype 1 early responders with 36 week pegylated interferon and ribavirin therapy
Sood A, Midha V, Goyal O
Language: English
References: 18
Page: 503-509
PDF size: 126.06 Kb.
ABSTRACT
Introduction. Standard treatment for patients with chronic hepatitis C genotype 1 (CHC G-1) infection includes
pegylated interferon plus ribavirin (PEG-RBV) for 48 weeks. Shorter treatment regimen would be
more acceptable due to lower cost and fewer side-effects. We aimed to compare the efficacy of 36 week
PEG-RBV therapy with standard 48 week therapy in CHC G-1 patients who achieve complete early virological
response (cEVR).
Material and methods. Consecutive treatment-naïve patients with CHC G-1 were treated
with pegylated interferon a2b (1.5
µg/kg/week) or α2a (180 µg/week) and weight based ribavirin.
Patients who achieved cEVR at 12 weeks [undetectable HCV RNA irrespective of RVR (rapid virological
response)] were randomized into- group A (48 weeks therapy) and group B (36 weeks therapy). Primary
end-point was achievement of sustained virological response (SVR) at 24 weeks of follow up.
Results. Out
of the total 166 patients started on treatment, 112 (69.3%) achieved cEVR, and were randomized into
group A (n = 59) and group B (n = 53). Fifty-five (93.2%) patients in group A and 50 (94.3%) in group B
completed therapy. The overall SVR rate in group A was 79.6% (47/59) and group B was 84.9% (45/53)
(p = 0.622). SVR rates in the two groups were comparable in all patient sub-groups according to factors
like viral load (≤ or › 400,000 IU/mL), RVR (achieved/not achieved), age (≤ or › 40 years), body mass index
(≤ or › 27) and cirrhosis (present/absent).
Conclusion. In CHC G-1 patients who achieve cEVR, 36 weeks
PEG-RBV therapy is as effective as standard 48 weeks therapy, irrespective of other host or virological factors.
REFERENCES
Ghany MG, Strader DB, Thomas DL, Seeff LB, American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009; 49: 1335-74.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatitis C virus infection. J Hepatol 2014; 60: 392-420.
Hadziyannis SJ, Sette H Jr, Morgan TR, Balan V, Diago M, Marcellin P, Ramadori G, et al. Peginterferon alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med 2004; 140: 346-55.
Jensen DM, Morgan TR, Marcellin P, Pockros PJ, Reddy KR, Hadziyannis SJ, Ferenci P, et al. Early identification of HCV genotype 1 patients responding to 24 weeks peginterferon alpha-2a (40 kd)/ribavirin therapy. Hepatology 2006; 43: 954-60.
Ferenci P, Laferl H, Scherzer TM, Gschwantler M, Maieron A, Brunner H, Stauber R, et al; Austrian Hepatitis Study Group. Peginterferon alfa-2a and ribavirin for 24 weeks in hepatitis C type 1 and 4 patients with rapid virological response. Gastroenterology 2008; 135: 451-8.
Liu CH, Liu CJ, Lin CL, Liang CC, Hsu SJ, Yang SS, Hsu CS, et al. Pegylated interferon-alpha-2a plus ribavirin for treatment-naive Asian patients with hepatitis C virus genotype 1 infection: a multicenter, randomized controlled trial. Clin Infect Dis 2008; 47: 1260-9.
Lin KH, Yu HC, Hsu PI, Tsai WL, Chen WC, Lin CK, Chan HH, et al. Baseline high viral load and unfavorable patterns of alanine aminotransferase change predict virological relapse in patients with chronic hepatitis C genotype 1 or 2 obtaining rapid virological response during antiviral therapy. Hepat Mon 2013; 13: e11892.
Ganne-Carrié N, Ziol M, de Ledinghen V, Douvin C, Marcellin P, Castera L, Dhumeaux D, et al. Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver disease. Hepatology 2006; 44: 1511-7.
Ferenci P. Predicting the therapeutic response in patients with chronic hepatitis C: the role of viral kinetic studies. J Antimicrob Chemother 2004; 53: 15-8.
Aspinall RJ, Pockros PJ. Review article: the management of side effects during therapy for hepatitis C. Aliment Pharmacol Ther 2004; 20: 917-29.
Manns M, McHutchinson J, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, Goodman ZD, et al. Peg-interferon alfa -2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001; 358: 958-65.
Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Gonçales FL Jr, Häussinger D, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis virus infection. N Eng J Med 2002; 347: 975-82.
Ridruejo E, Adrover R, Cocozzella D, Fernández N, Reggiardo MV. Efficacy, tolerability and safety in the treatment of chronic hepatitis C with combination of PEG-Interferon-Ribavirin in daily practice. Ann Hepatol 2010; 9: 46-51.
Gidding HF, Law MG, Amin J, Ostapowicz G, Weltman M, Macdonald GA, Sasadeusz JJ, et al. Hepatitis C treatment outcomes in Australian clinics. Med J Aust 2012; 196: 633-7.
Pariente A, Lahmek P, Duprat C, Denis J, Faroux R, Renou C, Nalet B, et al. Treatment of chronic hepatitis C with pegylated interferon and ribavirin in treatment-naive patients in ‘true life’: a plea in favor of independent post marketing evaluations. Eur J Gastroenterol Hepatol 2010; 22: 1297-302.
Sood A, Midha V, Goyal O, Hissar S, Sharma SK, Khanna P. Treatment of Chronic Hepatitis C with Pegylated Interferon plus Ribavirin in treatment-naive ‘real-life’ patients in India. Indian J Gastroenterol 2014 Mar 12 [Epub a head of print].
Zeuzem S, Buti M, Ferenci P, Sperl J, Horsmans Y, Cianciara J, Ibranyi E, et al. Efficacy of 24 weeks treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C infected with genotype 1 and low pretreatment viremia. J Hepatol 2006; 44: 97-103.
Rodriguez-Torres M, Sulkowski MS, Chung RT, Hamzeh FM, Jensen DM. Factors associated with rapid and early virologic response to peginterferon alfa-2a/ribavirin treatment in HCV genotype 1 patients representative of the general chronic hepatitis C population. J Viral Hepat 2010; 17: 139-47.