Some
Patients with Genotype 1 Chronic Hepatitis C May Benefit from Prolonged Treatment
with Pegylated Interferon plus Ribavirin
In
an effort to improve rates of sustained response to interferon-based
therapy for hepatitis C, researchers have
explored various strategies for tailoring drug doses and treatment durations to
meet the needs of individual patients.
As
reported in the October 2007 Journal of Hepatology, 3 hepatology experts
-- Patrick Marcellin, MD, from France, Jenny Heathcote, MD, from Canada, and Antonio
Craxi, MD, from Italy -- reviewed how on-treatment response might best be used
to predict eventual outcomes and adjust therapy accordingly to improve the chance
of sustained virological response (SVR).
"The
on-treatment virological response to pegylated interferon plus ribavirin therapy
is a useful tool in the management of patients with chronic hepatitis C,"
they wrote. "The time at which hepatitis C virus RNA becomes undetectable
by a sensitive PCR assay has a huge impact on the probability of achieving a sustained
virological response, particularly in genotype
1 patients, and may be useful in selecting patients for prolonged therapy."
They
emphasized that "indiscriminate extension of treatment in patients with hepatitis
C virus genotype 1 is not beneficial," because this adds to side effects
and cost and many patients will derive no benefit from the additional time on
therapy.
However, there is a subgroup of genotype 1 patients -- so-called
"slow responders" -- who do benefit from extending treatment from the
standard 48 weeks to 72 weeks. These individuals "can be readily identified
after 4-12 weeks of combination therapy," based on their HCV viral load at
that point, the authors wrote. The trick is to distinguish at this stage between
slow responders and "null responders" -- those who will not respond
even with longer therapy.
In the TeraVIC-4 study, virological relapse
rates were significantly lower, and SVR rates were significantly higher, among
patients treated with pegylated
interferon alfa-2a (Pegasys) plus ribavirin for 72 weeks compared with the
usual 48 weeks (45% vs 32%, respectively; P=0.014).
"Patients are
best served by quantitative determination of the hepatitis C virus RNA level at
weeks 4, 12 and 24," the authors wrote in conclusion. "The results of
these determinations can then be used to tailor the length of therapy."
10/19/07
Reference P
Marcellin, EJ Heathcote, A Craxi. Which patients with genotype 1 chronic hepatitis
C can benefit from prolonged treatment with the 'accordion' regimen? Journal
of Hepatology 47(4): 580-587. October 2007.
