Sustained virologic response to peginterferon α-2a and ribavirin in 335 patients with chronic hepatitis C: A tertiary care center experience

Abstract

Background/Aim:This retrospective study assessed the efficacy, safety, and the predictors of sustained viral response (SVR) to a 48-week-course of peginterferon α-2a (Pegasys) and ribavirin combination therapy in 335 consecutive Saudi patients with chronic hepatitis C virus (HCV) infection.Materials and Methods:Clinical, biochemical, and virological parameters were collected at time 0 (pretreatment) and at 12, 24, 48, and 72 weeks posttreatment. The mean ± SD age was 49.1 ± 13.0 years; 229 (68.4%) were males, mean ± SD body mass index was 27.8 ± 7.4, 85 (25.4%) were diabetic, 25 (7.5%) had renal impairment, 136 (40.6%) had previously received interferon ± ribavirin therapy, and 247 (73.7%) underwent pretreatment liver biopsy. Patients with genotypes 1, 2 or 3, 4 and mixed genotype were 60 (22.15%), 30 (11.0%), 148 (54.4%), and 34 (12.5%), respectively.Results:Early viral response (≥2-log10 HCV-RNA decline 12 weeks posttreatment) was achieved in 253 (75.3%). Patients who completed 48 weeks of treatment were 292 (87.1%); of these, 121 (75.6%) achieved ETVR, 161 (55.1%) continued to have SVR and 60 (20.5%) had a viral relapse following end-of-treatment response, that is 48.1 and 17.9% of all patients (n = 335), respectively. Nonresponders (NR) were 71 (24.3%) patients and 43 (12.8%) were unable to complete treatment (due to side effects or loss to follow up). Compared to the relapsers, patients with SVR were significantly younger (P = 0.000), nondiabetics (P = 0.015), had higher serum albumin (P = 0.007), had less pretreatment inflammatory grade (P = 0.011), infected with genotypes 2 or 3 (P = 0.014), and treatment-naïve patients (P = 0.001). However, in stepwise multivariate logistic regression analysis, only treatment naiveté and low pretreatment inflammatory score were the independent predictors of SVR (P = 0.005 and P = 0.018, respectively).Conclusion:Combination therapy, if tolerated and completed, is effective in treating chronic HCV patients, especially those with no previous interferon therapy and lower pretreatment inflammatory grade.

Osteopontin as a marker for response to pegylated interferon Alpha-2b treatment in Chronic HCV Saudi patients

“…This is comparable with response rate (63%) predicted by Al Ashgar et al, 19 but is higher compared to that reported by kamal et al, 20 which was 48 %. And is lower compared to that reported by Al Ashgar et al, 21 which was (75.6%).…”

Predictors of sustained virological response to a 48-week course of pegylated interferon alfa-2a and ribavirin in patients infected with hepatitis C virus genotype 4

“…This needs to be confirmed in another prospective trial. We have recently published a study involving 335 patients with HCV infection of all genotypes 61. It showed that the response of genotype 4 patients to combination therapy is more or less similar to genotype 1.…”

Sustained virological response in a predominantly hepatitis C virus genotype 4 infected population

“…One of the possible explanations for this relatively low SVR is the use of an 800 mg fixed dose of ribavirin daily. More recently Al Ashgar et al [8] published their results in which 335 patients treated with PEG-IFN a-2a and ribavirin achieved an SVR rate of around 48%. In this study, they adjusted the ribavirin dose according to the body weight.…”

“…The data on treating hepatitis in the Middle East, in which genotype 4 predominates, is limited. A recent study assessing sustained virological response (SVR) in Saudi Arabia revealed an SVR rate of around 48% in patients infected with HCV genotype 4; however, only PEG-IFN a-2a (PEGASYS) was used and they also included patients who were considered difficult to treat [8] . Limitations of other studies include small number of patients, use of conventional interferons, and the lack of viral genotype data [9] .…”