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Short-term Treatment Duration for HCV Genotypes 2 and 3 Patients
It
is well known that HCV
genotypes 2 and 3 patients have significantly higher sustained
response rates (SVR) to treatment compared to genotypes
1 and 4 patients. Prior studies have also demonstrated
that 12-14 weeks treatment is effective in genotype 2 or 3 HCV patients
who become HCV undetectable
after 4 weeks of therapy rapid
virologic response (RVR) or Super
Responders (SR).
In
this retrospective study, 2 data sets of patients from Italy and Norway
were pooled with the objective of identifying predictors of sustained
virological response (SVR), RVR and relapse
after short term treatment (12-14 weeks or 24 weeks) with peginterferon
alfa-2b (PegIntron) (1.0, n=281 or 1.5 μg/kg, n=122) plus ribavirin
(800-1200 mg). Dosing depended on negative or positive HCV RNA at week
4.
The
primary endpoint was undetectable HCV-RNA 24 weeks after therapy (SVR).
Results
SVR was obtained in 313/403 patients (78%).
SVR differed between cases with or without RVR (85% vs 62%), mild or bridging
fibrosis/cirrhosis (82% vs 67%), absent/mild or moderate/severe steatosis
(84% vs 72%), HCV-2 or -3 (81% vs 73%) low or high viremia (80% vs 67%).
RVR, mild fibrosis,
and HCV-2 were independent predictors of SVR.
RVR was obtained in 274/403 (68%) patients, 163/242 (67%) HCV2, and 111/161
(69%) HCV-3.
Patients with RVR had, as compared to those without RVR, more frequently low
grade steatosis (72% vs 64%), mild fibrosis (70% vs 63%, and high PegIFN
dose (78% vs 64%).
RVR was independent of viral load.
absence of severe fibrosis independently predicted RVR.
In RVR patients, SVR was achieved in 85% of both HCV-2 and HCV-3.
Virologic relapse was observed in 29/274 RVR patients (10.6%), and was more
frequently observed among those with low ALT levels (14% vs 5%), high
viremia (14% vs 6%), and severe fibrosis (18% vs 8%).
Peg-IFN dose, steatosis
and genotype were not associated with risk of relapse.
Severe fibrosis and low ALT
were independent predictors of relapse.
In
conclusion, the authors write, In HCV-2 or -3, the HCV RNA status after
4 weeks of therapy may guide treatment duration. Short treatment duration
is effective in both HCV-2 and -3 patients with RVR, but those with severe
fibrosis are less likely to experience both RVR and SVR, and more frequently
relapse off therapy.
11/18/05
Reference
A
Andriulli and others. SHORT-TERM TREATMENT DURATION FOR HCV-2 AND HCV-3
INFECTED PATIENTS WITH CHRONIC HEPATITIS. Abstract 1234. Abstracts of the annual meeting of the American Association
for the Study of Liver Diseases (56th AASLD). November
11-15, 2005. San Francisco, CA.
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