Standard therapy for chronic hepatitis C virus (HCV) infection,
consisting of pegylated
interferon alfa-2a (Pegasys) or pegylated
interferon alfa-2b (PegIntron) in combination with ribavirin
for 24 or 48 weeks (depending on HCV genotype) leads to an overall
sustained virological response
(SVR) rate of approximately 50%.
of the reason for this suboptimal efficacy is that the treatment
can cause difficult side effects that cause many people to reduce
their drug doses or stop treatment prematurely. But several
supportive, or adjuvant, therapies can help patients stay on
treatment. These include:
to manage the common side effect of depression (which may
be started in advance for prevention);
(Procrit, Epogen) to increase production of red blood cells
and manage anemia (a side effect of ribavirin);
colony-stimulating factor (Neupogen, Neulasta) to increase
production of neutrophils, a type of white blood cell that
Cash and colleagues from Royal Victoria Hospital in Belfast
designed a study to assess the clinical impact and effect on
sustained response of blood-boosting adjuvant therapies used
during treatment with pegylated interferon plus ribavirin.
The analysis included 132 chronic hepatitis C patients (73%
men). All but 11 participants were treatment-naive, of whom
about 40% had hard-to-treat HCV genotypes 1, 4, or 6. The endpoint
of interest was SVR, or continued undetectable HCV viral load
24 weeks after completion of treatment.
patients (43.8%) used adjuvant therapies.
overall sustained response rate was 66.7%, but varied according
to HCV genotype:
1, 4, or 6: SVR 50.0%;
2 or 3: SVR 78.2%.
all treatment-naive participants, the SVR rate was 68.6%,
again varying by genotype:
1 (n = 51): 49.0%;
2 or 3 (n = 70): 82.9%.
on these findings, the researchers concluded, "With the
use of supportive adjuvant therapy, we achieved an overall SVR
of 66.7% and in treatment-naive patients 68.6%."
"In genotype 1 patients, SVR rates of up to 46% have been
reported in previous studies without the use of erythropoietin
and granulocyte colony-stimulating factor," they continued.
"We have demonstrated the SVR for genotype 1 can be improved
to 50% overall."
Investigator affiliations: Liver Unit, Royal Victoria Hospital,
WJ Cash, K Patterson, ME Callender, and NI McDougall. Adjuvant
therapy used in conjunction with combination therapy for chronic
hepatitis C improves sustained virus response rates in genotype
1 patients. Journal of Viral Hepatitis 17(4): 269-273
April 1, 2010.