Effects of adjuvant therapy on the outcomes of surgical management of extrahepatic biliary atresia

Abstract

Dalgard et al. 1 reported the results of a randomized controlled trial for 428 chronic hepatitis C patients with genotype 2/3 infection treated with pegylated interferon alpha 2b (peginterferon-2b; 1.5 g/kg) weekly and ribavirin (800-1400 mg) daily. Rapid virological response (RVR; undetectable hepatitis C virus RNA at week 4 of therapy) was obtained in 70.6% of patients, and 298 of them were randomized to 14 (n ϭ 148) or 24 (n ϭ 150) weeks of treatment. The authors reported a high sustained virological response (SVR) rate after 14 weeks of treatment (81.1%), although longer treatment may give slightly better SVR (90.7%), and they recommended treating patients with genotype 2 or 3 and RVR for only 14 weeks for economic savings and fewer side effects.The authors' report supported our previous results from a randomized controlled trial of Taiwanese chronic hepatitis C patients with genotype 2 infection, which showed that patients who had achieved an RVR had equal efficacy between 16 and 24 weeks of peginterferon-2a with weightbased ribavirin. 2 Although some studies have also shown that a shorter course of therapy over 12-16 weeks with peginterferon/ribavirin is as effective as a 24-week course for genotype 2 patients with satisfactory response at week 4, 3,4 Shiffman et al. 5 recently suggested that patients with genotype 2 or 3 should be treated for the currently recommended 24 weeks rather than 16 weeks, which seemed inferior to a fixed 24-week regimen. The different RVR rates between our patients and other studies seemed noteworthy. In Taiwanese genotype 2 patients, we found that an RVR was achieved by 86.7% of patients (86% and 87% in the 16-week and 24-week groups, respectively). 2 The RVR rates for genotype 2 patients were 75.0% (45/60), 64.6% (137/212), and 69.2% (504/728) in Scandinavia, 1 Italy, 3 and United States, 5 respectively. One of the possible causes of the RVR rate being higher among genotype 2 patients is that the mean body weight is lower in Taiwan (around 66 kg) 2 than in Western countries (around 78, 1 69, 3 and 84 kg 5 ). In addition to the higher mean initial dose of ribavirin (15-20 mg/kg/day for our patients), the higher initial dose of ribavirin administered by Dalgard et al. 1 at a dosage of 800 to 1400 mg/day based on body weight (Ͻ65 kg, 800 mg/day; 65-85 kg, 1000 mg/day; 86-105 kg, 1200 mg/day; and Ͼ105 kg, 1400 mg/day) might lead to a higher RVR rate (75%) than the fixed initial daily dose (800 mg) with a highest mean body weight (around 84 kg) by Shiffman et al. 5 The doses of peginterferon and ribavirin and RVR are all important factors for therapeutic response. A higher SVR rate was reported to be associated with higher average doses of peginterferon or ribavirin per kilogram of bodyweight by Manns et al. 6 Reddy et al. 7 reported that as long as patients achieved RVR, ribavirin dose reductions had minimal impact on SVR. Accordingly, determining whether a shorter course with a higher initial dose of ribavirin combined with peginterferon for genotype 2 patients may achieve a...