New proposal for response‐guided peg‐interferon‐plus‐ribavirin combination therapy for chronic hepatitis C virus genotype 2 infection

Abstract

This study aimed to determine the most suitable duration of pegylated-interferon (Peg-IFN)-plus-ribavirin combination therapy in patients infected with hepatitis C virus (HCV) genotype 2 who had not achieved rapid virological response (serum HCV RNA disappearance after 4 weeks of therapy). HCV genotype 2 patients (n = 182) with a high viral load received >80% of the standard Peg-IFN-plus-ribavirin dose for at least 24 weeks, and their final virological responses were studied. Patients were classified into "rapid virological response" and "non-rapid virological response" groups. The non-rapid virological response group was further divided into a "virological response at 8 weeks" (serum HCV RNA disappearance after 8 weeks of therapy) and a "non-virological response at 8 weeks" group. Factors related to rapid virological response and optimal therapy duration in the non-rapid virological response group were evaluated. Multivariate logistic regression analysis showed that subtype HCV genotype 2a (P = 0.0015) and low concentration of pretreatment serum HCV RNA (P = 0.0058) were independent factors in a rapid virological response. In the virological response at 8 weeks group, the sustained virological response rate after 24 weeks of therapy was significantly lower than after 36 weeks (P = 0.044) or after 48 weeks (P = 0.006), and was similar for 36- and 48-weeks. The cost for achieving (CAS) one sustained virological response was lowest with 36-week therapy. Prolongation of Peg-IFN-plus-ribavirin combination therapy to 36 weeks is suitable for achieving virological response at 8 weeks, given the high, sustained virological response rate and cost benefit.

Peginterferon plus weight-based ribavirin for treatment-naïve hepatitis C virus genotype 2 patients not achieving rapid virologic response: a randomized trial

“…In this study, we demonstrated that 48-week treatment with Peg-IFN plus weight-based RBV provided a greater SVR rate than 24-week treatment (70.2% versus 46.2%) in treatment-naïve HCV-2 patients not achieving RVR. Our results were in line with previous reports from U.S. and Japan showing that the beneficial effects of extending the treatment duration to 36–48 weeks for these patients 21 22 . In the N-CORE study, Shiffman et al .…”

“…In patients with HCV-2 infection, those achieving rapid virologic response (RVR) have comparable SVR rates by a truncated (12–16 weeks) or standard (24 weeks) duration of Peg-IFN plus RBV therapy 12 18 19 . However, in HCV-2 patients not achieving RVR, the benefits of improving the SVR rates by extending the treatment duration from 24 weeks to 36–48 weeks or by using weight-based (1,000–1,200 mg/day) rather than flat (800 mg/day) RBV dosages are controversial 20 21 22 23 . Although the SVR rates in HCV-2 patients achieving RVR by Peg-IFN plus RBV are similar regardless of interleukin-28B (IL-28B) genotypes, the role of IL-28B genotypes in HCV-2 not achieving RVR has not been fully elucidated 23 24 25 26 .…”

Comparison of HCV viral load and its genotype distributions in HCV mono- and HIV/HCV co-infected illicit drug users

“…High Mir-122 level, less favorable IL-28 (CT or TT) polymorphism and African-American race are the main host factor leading to poorer SVR [19]. …”

Increased prevalence of hepatitis C virus subtype 6a in China: a comparison between 2004–2007 and 2008–2011

“…Subtype 1b is prevalent worldwide [3], while the other genotypes are typically confined to regional epidemics. In brief, subtype 1a is most commonly seen in the USA [4]; subtype 2a and 2b are predominant in North America, Europe and Japan [5–7]; HCV-3 (predominantly 3a) is the most prevalent genotype in India and Pakistan [8, 9]; genotype 4 is often found in the Middle East and Africa [3]; subtype 5a accounts for at least 50 % of the infections in South Africa [10] and genotype 6 (HCV-6) is frequently seen in southern China and Southeast Asia [11–13]. Furthermore, the genotype reportedly confers a different individual response to the commonly used combination therapy interferon (IFN) + ribavirin (RBV).…”