Pegylated interferon alpha-2b plus ribavirin in patients with genotype 4 chronic hepatitis C: The role of rapid and early virologic response

Abstract

In patients chronically infected with hepatitis C virus (HCV) genotype 4, the optimum duration of therapy and the predictors of sustained virologic response (SVR) have not been adequately determined. In this study, 358 patients with chronic hepatitis C genotype 4 were randomly assigned to pegylated interferon (PEG-IFN) alpha-2b (1.5 g/kg/week) plus oral ribavirin (10.6 mg/kg/day) for a fixed duration of 48 weeks (control group, n ‫؍‬ 50) or for a variable duration (n ‫؍‬ 318). In the variable-duration group, patients with undetectable HCV RNA at week 4 were treated for 24 weeks (group A, n ‫؍‬ 69), patients with undetectable HCV RNA at week 12 were treated for 36 weeks (group B, n ‫؍‬ 79), and the rest of the patients were treated for 48 weeks (group C, n ‫؍‬ 160). The primary endpoint was SVR (undetectable HCV RNA 24 weeks after treatment cessation). Groups A-C and the control group had SVR rates of 86%, 76%, 56%, and 58%, respectively. After the study was controlled for predictors, a low baseline histologic grade and stage were associated with SVR (P < 0.029) in all groups. In addition, among patients in group C, older age (P ‫؍‬ 0.04), a higher baseline body mass index (P ‫؍‬ 0.013), and low baseline HCV RNA (P < 0.001) were also associated with SVR attainment. The incidence of adverse events and the rate of discontinuation were higher in patients in the variable-duration and fixed-duration groups treated for 48 weeks. Conclusion: In patients with chronic hepatitis C genotype 4 and undetectable HCV RNA at weeks 4 and 12, treatment with PEG-IFN alpha-2b and ribavirin for 24 weeks and 36 weeks, respectively, is sufficient. (HEPATOLOGY

The Efficacy of aHansenula-Derived 20 kDa Pegylated Interferon Alpha-2a in the Treatment of Genotype 4 Chronic Hepatitis C

“…The presence of such a cheaper yet effective alternative will immensely aid the national efforts to eradicate HCV. Interim responses also compared similarly, yet our RVR rate was unexpectedly high (54%) in comparison to previous reports of only 16%-45% with 40 kDa interferon (Kamal and others 2007;Ferenci and others 2008). We postulated that this might be due to the strict measures we took to ensure compliance in the early weeks of treatment, but this argument, however, fails to explain why the high RVR did not translate to higher ETR and SVR rates.…”

Pegylated interferon alfa-2b plus ribavirin for treatment of chronic hepatitis C

“…In the current study, all genotype 1 patients (n = 7) who achieved RVR also attained SVR; while a study reported a SVR rate of 86.8% in patients with RVR [15] . In genotype 4 patients, 80% with RVR attained SVR, whereas the published study reported 86% [23] . Similarly, among the genotype 3 patients who had RVR, 83.3% attained SVR, which is similar (83.7%) to that reported in the literature [24] .…”

Overwhelming Postsplenectomy Infection for Splenectomized HCV Patients

“…Although sustained viral response after treatment with interferon alfa monotherapy was 10% -15%, the addition of ribavirin significantly improved the response rated to 30% -40% [6]. Most recently, the use of pegylated interferon has further improved response rate, and more than half of the treated patients can expert to have a sustained response with combination therapy using peginterferon and ribavirin [7].…”