Extended Pegylated Interferon plus Ribavirin Therapy Improves Sustained Response Rate in Slow Responder Genotype 1b Hepatitis C Patients

By Liz Highleyman

A considerable proportion of chronic hepatitis C patients do not achieve sustained virological response (SVR) to standard therapy with pegylated interferon plus ribavirin for 24 weeks (for HCV genotypes 2 or 3) or 48 weeks (for genotypes 1 or 4), leading researchers to study the benefits of longer treatment. While some studies have seen good outcomes with 72 weeks of therapy, the optimal duration is unknown

In a study reported in the January 2009 American Journal of Gastroenterolgy, 113 hard-to-treat genotype 1b patients with high pre-treatment HCV viral load were randomly assigned to receive pegylated interferon plus ribavirin for the standard 48-week duration or for an extended duration. In the extended duration group, treatment continued for 44 weeks after patients became HCV RNA negative, for a total duration of 48 to 68 weeks.

Results

The SVR rate was 36% (20 of 56) in the standard duration group compared with 53% (30 of 57) in the extended duration group -- a difference that did not reach statistical significance (P = 0.07).

However, patients in the extended duration group who became HCV RNA negative between weeks 16 and 24 had a significantly higher SVR rate than patients in the standard duration group (78% [7 of 9] vs 9% [1 of 11]; P = 0.005).

The predictive factors for SVR were longer treatment duration and time to undetectable HCV RNA.

Based on these findings, the study authors concluded, "The extended treatment significantly increased the SVR rate in patients who were HCV RNA negative at 16-24 weeks."

Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka-ken, Japan.

2/03/09

Reference
T Ide, T Hino, K Ogata, and others. A Randomized Study of Extended Treatment With Peginterferon alpha-2b Plus Ribavirin Based on Time to HCV RNA Negative-Status in Patients With Genotype 1b Chronic Hepatitis C. American Journal of Gastroenterolgy 104(1): 70-75. January 2009. (Abstract).