Adjuvant therapy used in conjunction with combination therapy for chronic hepatitis C improves sustained virus response rates in genotype 1 patients

Abstract

Combination treatment with pegylated interferon (Peg-IFN) and ribavirin remains the gold standard in the treatment of chronic hepatitis C. This therapy is limited by many side-effects including anaemia, neutropenia and reduced quality of life. The use of adjuvant agents to reduce the frequency of dose reductions because of haematological side-effects has been proven to be effective but there are few reports of what effect the use of these adjuvant therapies is having on sustained virological response (SVR). The aim of the study was to assess the clinical impact on sustained virological response of adjuvant therapies during combination therapy with Peg-IFN and ribavirin for chronic hepatitis C. A total of 132 patients, 96 males, were included in the study. The overall SVR was 66.7%, with 50% of genotype 1/4/6 (n = 27/54) patients achieving SVR and 78.2% of genotypes 2/3. The overall SVR of the treatment naïve patients (83/121) was 68.6%. Fifty-one of these patients were genotype 1 with 49.0% (25/51) of this group achieving SVR. The genotype 2/3 group of treatment naïve patients reached an SVR of 82.9% (58/70). Adjuvant therapy was used in 57 patients (43.8%). With the use of supportive adjuvant therapy, we achieved an overall SVR of 66.7% and in treatment naïve 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. We have demonstrated the SVR for genotype 1 can be improved to 50% overall.

Epoetin alpha improves the response to antiviral treatment in HCV-related chronic hepatitis

“…The results of previous studies [27,28,30,37,49,50,52,[56][57][58] and the present study have shown that the introduction of Epoetin Alpha therapy in patients treated with PEG-interferon alpha-2A and RBV for CH related to genotype 1b HCV infection leads to an improved adherence to treatment, and, consequently, to a significant improvement of SVR.…”

“…However, some studies have used decision analysis to estimate the cost-effectiveness of adjunctive therapy with erythropoietic growth factor (EGF) compared with that of standard care in the treatment of hepatitis C. The use of EGFs appears to be costeffective in patients with anaemia who are receiving combination therapy for HCV genotype 1, 2 or 3. Compared with The results of previous studies [27,28,30,37,49,50,52,[56][57][58] and the present study have shown that the introduction of Epoetin Alpha therapy in patients treated with PEG-interferon alpha-2A and RBV for CH related to genotype 1b HCV infection leads to an improved adherence to treatment, and, consequently, to a significant improvement of SVR.…”

“…In the Casch WJ et al paper the aim of the study was to assess the clinical impact on sustained virological response of adjuvant therapies (erythropoietin and granulocyte colony stimulating factor) during combination therapy with Peg-IFN and ribavirin for chronic hepatitis C; the authors have shown that, in CH genotype 1 related, the SVR can be improved with the use of erythropoietins [52].…”

“…It may be assumed that there is no cost-benefit relationship for the use of Epoetin Alpha in patients with cirrhosis, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r P e e r R e v i e w standard care, adjuvant therapy with EGF, may increase the probability of achieving an SVR, increase unadjusted lifespan, and improve quality-adjusted lifespan at an acceptable cost [52,[53][54][55].…”

Critical review of the use of erythropoietin in the treatment of anaemia during therapy for chronic hepatitis C

“…From the data available, EPO itself exerts no additional antiviral activity, but the higher ribavirin doses tolerated with EPO administration may favour elimination of HCV. Indeed, four trials specifically assessed the rates of SVR between patients receiving PegIFN and ribavirin with and without EPO [21,46,47,49]. Shiffman et al.…”