| Comparison of
48 vs 72 Weeks of Treatment with Peginterferon Alfa-2a plus Ribavirin in Patients
with HCV Genotype 1 In
order to improve treatment outcomes of chronic hepatitis
C (CHC) among individuals with HCV genotype 1 it is necessary to employ innovative
strategies. One possible approach is to extend the period of treatment of CHC
beyond 48 weeks. Researchers
at the University of Berlin conducted a comparative study of the safety and efficacy
of treatment with peginterferon
alfa-2a (Pegasys) 180 microgram/wk plus ribavirin (Copegus) 800 mg daily for
48 weeks (group A, 230 pts) vs 72 weeks (group B, 225 pts). All study participants
had HCV genotype 1 and all were treatment-naïve. On-treatment
and sustained virologic response (SVR) 24 weeks after stopping treatment was assessed
by qualitative reverse-transcription polymerase chain reaction assay (sensitivity
50 IU/mL). Results 
Overall, no significant differences were observed in the treatment outcome between
the two groups.
End-of-treatment
and SVR rates in groups A and B were 71% vs 63% and 53% vs 54%, respectively.
Patients
with undetectable HCV-RNA levels at weeks 4 and 12 had excellent SVR rates ranging
from 76% to 84% regardless of treatment group, whereas patients shown to be still
HCV-RNA positive at week 12 achieved significantly higher SVR rates when treated
for 72 instead of 48 weeks (29% vs 17%, P = .040).
A particular benefit from extended treatment duration was seen in patients with
low-level viremia (<6000 IU/mL) at week 12.
The frequency and intensity of adverse
events was similar between the 2 groups.
Based
on these findings, the authors conclude, "Extended treatment duration generally
is not recommended in HCV type 1 infection and should be reserved only for patients
with slow virologic response defined as HCV-RNA positive at week 12 but negative
at week 24." 05/16/05 Reference
T
Berg, M von Wagner, S Nasser, and others. Extended Treatment Duration for Hepatitis
C Virus Type 1: Comparing 48 Versus 72 Weeks of Peginterferon-Alfa-2a Plus Ribavirin.
Gastroenterology 130(4): 1086-1097. April 2006. Suggested
Reading
M von
Wagner, M Huber M, T Berg, and others. Peginterferon-alpha-2a (40KD) and ribavirin
for 16 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C. Gastroenterology
129(2): 522-527. August 2005. P
Ferenci P, M W Fried, M L Shiffman, and others. Predicting sustained virological
responses in chronic hepatitis C patients treated with peginterferon alfa-2a (40
KD)/ribavirin. Journal of Hepatology 43(3): 425-433. September 2005.
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