A reduced dose of ribavirin does not influence the virologic response during pegylated interferon alpha-2b and ribavirin combination therapy in patients with genotype 1 chronic hepatitis C

Abstract

Background/AimsWhen combined with pegylated interferon alpha-2b (Peg-IFN α-2b) for the treatment of genotype 1 chronic hepatitis C (CHC) in Korea, the current guideline for the initial ribavirin (RBV) dose is based on body weight. However, since the mean body weight is lower for Korean patients than for patients in Western countries, current guidelines might result in Korean patients being overdosed with RBV.MethodsWe retrospectively reviewed the medical records of patients with genotype 1 CHC who were treated with Peg-IFN α-2b and RBV combination therapy. We divided the patients into groups A (≥15 mg/kg/day, n=23) and B (<15 mg/kg/day, n=26), given that the standard dose is 15 mg/kg/day. The clinical course in terms of the virologic response, adverse events, and dose modification rate was compared between the two groups after therapy completion.ResultsThe early response rates (92.0% vs. 83.3%, P=0.634) and sustained virologic response rates (82.6% vs. 73.1%, P=0.506) did not differ significantly between the two groups. During the treatment period, the RBV dose reduction rate was significantly higher in group A than in group B (60.9% vs. 23.1%, P=0.01).ConclusionsRBV dose reduction is performed frequently when patients are treated according to the current Korean guidelines. Given that lowering the RBV dose did not appear to decrease the virologic response during therapy, reducing RBV doses below the current Korean guideline may be effective for treatment, especially in low-weight patients.

The Impact of Inosine Triphosphatase Variants on Hemoglobin Level and Sustained Virologic Response of Chronic Hepatitis C in Korean

“…It is widely recognized that age and IL28B (rs8099917) are associated with SVR (Table 3), and in patients with anemia, it can be inferred that RBV dose reduction could decrease treatment efficacy. However, according to previous studies, the reason of this discrepancy between RBV dose reduction and SVR is controversial (8, 11). There are several possible explanations for this discrepancy.…”

“…There are several possible explanations for this discrepancy. First, other risk factors, such as, an advanced age and histologic disease status, can confuse attempts to determine whether RBV dose reduction is responsible (8). Second, RBV dose reduction is the only mechanism whereby ITPA variants might associated with virological response (11).…”

“…RBV is directly toxic to erythrocytes and is associated with hemolysis via guanosine triphosphate pool depletion and the acceleration of erythrocytosis. However, RBV-induced anemia is usually reversible and dose-related (7, 8). …”