Peginterferon/ribavirin treatment achieves a higher compliance rate than interferon/ribavirin combination in patients chronically infected with HCV on methadone maintenance
ABSTRACT Chronic hepatitis C virus infection (HCV) is the most common infectious disease among intravenous drug users.
To determine and compare compliance rates between two groups of chronic HCV patients from the methadone substitution program of the National Greek Organization Against Drugs treated with either pegylated interferon alpha-2b/ribavirin or with interferon alpha-2b/ribavirin during 48 weeks of therapy and 24 weeks of follow-up. Furthermore, to evaluate the efficacy of each treatment modality.
Forty-five consecutive methadone maintenance (MM) patients (group A, 36 males, nine females) were treated with pegylated interferon alpha-2b (weight-based dosing 1.5 microg/kg/week) and ribavirin 1000-1200 mg/day orally. Sixty-five consecutive MM patients (group B, 52 males, 13 females) were treated with interferon alpha-2b (6 MIU, three times/week) and ribavirin with the doses reported above. During the study, all patients were followed up periodically by hepatologists, internists, and psychiatrists.
Baseline characteristics were similar between the two groups. Thirty-four out of 45 patients (75.6%) from group A and 31 of 65 patients (47.7%) from group B completed therapy (P =0.006). Thirty-two (71.1%) patients from group A and 27 patients (41.5%) from group B were followed-up until the end of week 72 (P = 0.004). At the end of the follow-up, sustained virologic response was achieved in 23 of 45 (51.1%) patients from group A and 21 of 65 patients (32.3%) from group B (P =0.075).
Pegylated interferon alpha-2b/ribavirin treatment achieved a significantly higher compliance rate than interferon alpha-2b/ribavirin in MM patients with chronic HCV infection. After 24 weeks of follow-up, response rates were similar for patients who were compliant to treatment for both groups.
- SourceAvailable from: Don C Des Jarlais[Show abstract] [Hide abstract]
ABSTRACT: Background. Hepatitis C virus (HCV)-infected drug users (DUs) have largely been excluded from HCV care. We conducted a systematic review and meta-analysis of the literature on treatment completion and sustained virological response (SVR) rates in DUs. We assessed the effects of different treatment approaches and services to promote HCV care among DUs as well as demographic and viral characteristics.Methods. Studies of at least 10 DUs treated with pegylated-interferon/ribavirin that reported SVR were analyzed. Heterogeneity was assessed (Cochran's test), investigated (meta-regression), and pooled rates estimated (random effects).Results. Thirty-six studies including 2866 patients were retrieved. The treatment completion rate among DUs was 83.4% (95%CI: 77.1%; 88.9%). From studies that included addiction-treated and untreated patients during HCV therapy, the higher the proportion of addiction-treated patients, the higher the HCV treatment completion rate (p<0.0001). After adjusting for HIV/HCV co-infection, gender, and treatment of addiction, support services during antiviral therapy increased treatment completion (p<0.0001). The pooled SVR rate was 55.5% (95%CI: 50.6%; 60.3%). Genotype 1/4 (p=0.0012) and the proportion of HIV co-infected DUs (p=0.0173) influenced the SVR rate. After adjusting for HCV genotype 1/4 and HIV/HCV co-infection, the SVR rate was positively correlated with involvement of a multidisciplinary team (p<0.0001).Conclusions. Treatment of addiction during HCV therapy results in higher treatment completion. Our pooled SVR rate is similar to that obtained in registration trials in the general population. Treatment of addiction during HCV therapy will likely be important for HCV-infected DUs undergoing treatment with more complex regimens including direct acting antivirals.Clinical Infectious Diseases 12/2012; 56(6). DOI:10.1093/cid/cis1007 · 9.42 Impact Factor