Limitations of an 8-week Course of Pegylated interferon plus Ribavirin for Genotype 2 Hepatitis C Patients with Rapid Virological Response

Some recent data suggest that the duration of combination therapy with pegylated interferon plus ribavirin for patients with chronic hepatitis C virus (HCV) genotype 2 infection who achieve rapid virological response (RVR) after 4 weeks of treatment might be shortened to 8 weeks from the standard 24 weeks.

The aim of the current Japanese study, published in the April 1, 2008 advance online edition of Liver International, was to compare the efficacy of combination antiviral therapy with pegylated interferon plus ribavirin for 8 versus 24 weeks for the treatment of genotype 2 rapid responders.

The study initially enrolled 61 patients. Serum HCV RNA was not undetectable 4 weeks after the start of treatment in 32 patients. The 32 patients with RVR were the randomly assigned to receive continued treatment through week 8 (n=15) or week 24 (n=17) - that is, for either 4 or 20 additional weeks. There were no significant differences in patient characteristics in the 8-week and the 24-week treatment arms. Participants in the 8-week group who experienced relapse were offered a 24-week course of re-treatment.

Results

• Sustained virological response (SVR) was seen in 5 of 15 patients (33.3%) in the 8-week treatment arm and 14 of 17 (82.4%) in the 24-week arm.

• The SVR rate was significantly higher in the 24-week compared with the 8-week treatment group (P = 0.0140).

• 9 of 10 patients who relapsed in the 8-week treatment group underwent 24-week re-treatment, and 7 achieved SVR.

Conclusion

Based on their findings, the study authors concluded that after rapid virological response, "an 8-week regimen of combination antiviral therapy with peginterferon and ribavirin yielded an increase in the relapse rate, indicating the limitation of a reduction of treatment below 12 weeks" in patients with genotype 2 HCV.

Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.

4/25/08

Reference

H Toyoda, T Kumada, S Kiriyama, and others. Eight-week regimen of antiviral combination therapy with peginterferon and ribavirin for patients with chronic hepatitis C with hepatitis C virus genotype 2 and a rapid virological response. Liver International. April 1, 2008. [Epub ahead of print].

Related Articles

L Martin-Carbonero, M Nunez, A Marino, and others. Undetectable hepatitis C virus RNA at week 4 as predictor of sustained virological response in HIV patients with chronic hepatitis C. AIDS 22(1): 15-21. January 2008.

JW Yu, GQ Wang, LJ Sun, and others. Predictive value of rapid virological response and early virological response on sustained virological response in HCV patients treated with pegylated interferon alpha-2a and ribavirin. Journal of Gastroenterology and Hepatology 22(6): 832-836. June 2007.

ML Yu, CY Dai, JF Huang, and others. A randomised study of peginterferon and ribavirin for 16 versus 24 weeks in patients with genotype 2 chronic hepatitis C. Gut 56(4): 553-9. April 2007.

O Dalgard and A Mangia. Short-term therapy for patients with hepatitis C virus genotype 2 or 3 infection. Drugs 66(14):1807-1815. 2006.

ML Schiffman, F Suter, BR Bacon, and others (ACCELERATE Investigators). Peginterferon alfa-2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3. New England Journal of Medicine 357(2): 124-134. July 12, 2007.