Optimizing the dose and duration of therapy for chronic hepatitis C

Optimal Duration of Pegylated Interferon Plus Ribavirin Therapy for Chronic Hepatitis C Genotype 3 Patients who do not Achieve Rapid Virological Response

BACKGROUND/OBJECTIVES

Chronic hepatitis C (CHC) genotype-3 (G-3) patients treated with standard 24-week pegylated interferon plus ribavirin(PEG-RBV) therapy achieve sustained virological response(SVR) rate of 69-82%. Patients who do not achieve rapid virological response(RVR) have lower SVR rate. Data regarding optimal management of this subgroup is scarce. We aimed to determine the most appropriate treatment duration in CHC G-3 patients who do not achieve RVR.

METHODS

Treatment naïve CHC G-3 patients treated with PEG-RBV therapy were included in this retrospective analysis. Patients with cirrhosis were excluded. RVR was assessed in all patients beyond the year 2007. RVR non-achievers were advised extended treatment beyond 24 weeks.

RESULTS

Of the total 685 patients started on treatment, 646 completed treatment (mean age 39.1 ± 12 years, 68.3% males). In the pre-'RVR assessment' period (2004-2006), SVR with standard 24 week therapy was 72.3% (112/155). In post-'RVR assessment' period (2007-2013), 75.8% (402/530) patients achieved RVR; and 91.5% (368/402) of these achieved SVR with standard 24 weeks therapy. Among RVR non-achievers (n = 128), 51 patients opted for extended 36 week therapy, 12 for 48 week therapy, while 65 stopped therapy at 24 weeks. Choice of treatment duration was dependent entirely on the affordability of the patient. SVR with extended therapy (36/48 weeks) was significantly higher than standard 24 week therapy in RVR non-achievers (82.5% vs. 52.3%; P = 0.003). However, SVR rate in 36 week group was not significantly different from 48 week group (84.3% vs. 75%; P = 0.425]. On multivariate analysis, duration of treatment (36/48 week vs. 24 week; P < 0.001) was significantly associated with SVR.

CONCLUSIONS

SVR rates in CHC G-3 patients treated with PEG-RBV in northern India were comparable to western data. Standard 24 week therapy is adequate for RVR-achievers. However, in RVR non-achievers, extended 36 week therapy significantly improves SVR, while further extension to 48 week does not provide any additional advantage.

Efficacy of peg-interferon-α-2a plus ribavirin for patients aged 60 years and older with chronic hepatitis C in Korea

BACKGROUND AND AIM

In the present study, we evaluated the safety and efficacy of combination therapy with pegylated interferon and ribavirin for treating chronic hepatitis C (CHC) patients aged 60 years and older.

METHODS

A total of 314 CHC patients, who were treated with combination therapy, were classified into three groups according to age: (i) younger than 50 years (n = 137); (ii) 50-59 years (n = 109); and (iii) 60 years or older (n = 68). The sustained virological response (SVR) and discontinuation rates were compared between the three groups.

RESULTS

Discontinuation of therapy due to adverse event was more frequent in the older patient groups: 1%, 5%, and 10% for the < 50-year, the 50-59-year, and the ≥ 60-year patient groups, respectively (P = 0.018). However, the older patient groups showed a SVR rate that was comparable to the SVR rates of the other age groups: 80%, 73%, and 75% for the < 50-year, 50-59-year, and ≥ 60-year- patient groups, respectively (P = 0.420). A multivariate analysis showed that the aspartate aminotransferase : platelet ratio index (APRI) was an independent predictor of an SVR. An SVR was achieved in 95% (19/20) of the elderly patients with an APRI < 0.80.

CONCLUSIONS

Although physicians must pay more attention to adverse events in the older patients, combination therapy can be considered for older patients, especially for patients with a low APRI.