| 24-Week
Treatment is Sufficient for Most Genotype 1 Patients with Rapid Virological Response
Standard
therapy for chronic hepatitis C calls for 24 weeks of pegylated
interferon plus ribavirin for patients with genotype
2 or 3 HCV, and 48 weeks for those with harder-to-treat genotype
1. In an effort to reduce the side effects and cost of treatment, however,
researchers have explored whether certain patients might do well with shorter
courses of therapy. Several studies have shown that rapid virological response
at four weeks predicts long-term sustained
response after the completion of therapy. In
a previous randomized, multinational trial, approximately one-quarter of genotype
1 patients achieved sustained virological response
(SVR) with 24 weeks of treatment with pegylated
interferon alpha-2a (Pegasys) plus ribavirin. In
a study reported in the May 2006 issue of Hepatology, D.M. Jensen and colleagues
sought to identify which factors were associated with rapid virological response
(RVR) at week 4 (HCV RNA < 50 IU/mL) and SVR 24 weeks after the completion
of therapy. Results 
In the multinational trial, 51 out of 216 genotype 1 patients (24%) in the 24-week
treatment arms achieved RVR.
The SVR rate were nearly five higher among patients with RVR than among those
without (89% vs 19%, respectively).
Patients with baseline HCV RNA less than 200,000 IU/mL (OR 9.7, 95% CI 4.2-22.5;
P < .0001) or 200,000-600,000 IU/mL (OR 3.6, 95% CI 1.5-9.1; P
= .0057) were more likely to achieve RVR than those with HCV viral loads greater
than 600,000 IU/mL.
HCV subtype (1b vs 1a) was also independently associated with RVR (OR 1.8, 95%
CI 0.9-3.7; P = .0954).
RVR (OR 23.7 vs no RVR, 95% CI 9.1-61.7) and baseline HCV RNA less than 200,000
IU/mL (OR 2.7 vs > 600,000 IU/mL, 95% CI 1.1-6.3; P < 0.026) were
significant and independent predictors of SVR in genotype 1 patients treated for
24 weeks.
Conclusion The
authors concluded that patients with genotype 1 HCV who were treated with pegylated
interferon plus ribavirin achieved RVR after four weeks 24% of the time, which
portended an 89% SVR rate after the completion of therapy.
6/23/06 Reference
DM Jensen, TR Morgan,
P Marcellin, and others. Early identification of HCV genotype
1 patients responding to 24 weeks peginterferon alpha-2a
(40 kd)/ribavirin therapy. Hepatology. 43(5): 954-960. May 2006.
| 
