It remains unclear how we can shorten the treatment duration of antiviral combination therapy with peginterferon and ribavirin for patients with chronic hepatitis C virus (HCV) genotype 2 infection who achieved a rapid virological response (RVR).
We compared the efficacy of antiviral combination therapy with peginterferon and ribavirin for 8 vs. 24 weeks for the treatment of patients with HCV genotype 2 infection and with RVR.
Sixty-one patients were enrolled. Serum HCV RNA was not detected at 4 weeks after the start of treatment in 32 patients with an RVR. These 32 patients were randomly assigned to 8-week (n=15) or 24-week (n=17) treatment regimens. Patients in the 8-week group who relapsed underwent a 24-week retreatment.
No significant difference in patient characteristics was observed between the 8- and the 24-week treatment groups. A sustained virological response (SVR) was seen in five of 15 patients (33.3%) in the 8-week treatment group and 14 of 17 (82.4%) in the 24-week treatment group; the rate was significantly higher in the 24-week treatment group (P=0.0140). Nine of 10 relapsed patients in the 8-week treatment group underwent a 24-week retreatment, and seven achieved an SVR.
An 8-week regimen of combination antiviral therapy with peginterferon and ribavirin yielded an increase in the relapse rate, indicating the limitation of a reduction of treatment below 12 weeks in patients with genotype 2, after RVR.
"In the present cohort study, the rapid virological response rate and the sustained virological response rate with 24-week therapy for HCV genotype 2 patients were similar to those reported by several previous studies [Toyoda et al., 2009; Inoue et al., 2010]. As the sustained virological response rate exceeded 90% in patients who achieved rapid virological response in the present study, a therapy duration of 24 weeks was sufficient for patients who achieved a rapid virological response. "
[Show abstract][Hide abstract] ABSTRACT: Current guidelines recommend a duration of 24 weeks of treatment with pegylated interferon and ribavirin for patients infected with chronic hepatitis C virus (HCV) genotypes 2 and 3. Several trials investigated whether shorter treatment duration is equally effective in achieving sustained virological response (SVR). Our aim was to determine the optimal length of treatment in patients with HCV genotypes 2 and 3.
Systematic literature identified eight randomized controlled trials (RCTs). Meta-analyses were carried out on SVR data from three studies randomized at baseline and five studies randomized at rapid virological response (RVR) to either 12-16 weeks or a 24-week course.
Pooled SVR data were higher in standard treatment in RCTs that randomized at baseline, with a relative risk (RR) of 0.88 (95% confidence interval [CI] 0.76-1.01). The pooled proportion of SVR rates of RCTs that randomized at RVR were similar in the short treatment group (82%) as in the standard treatment (83%), with the pooled effect given by a RR of 1.00 (95% CI 0.92-1.09).
A shorter course (12-16 weeks) of combination therapy does not impair efficacy compared with a 24-week course in HCV genotypes 2 and 3 patients who achieve an RVR. HCV patients without RVR should consider 24 weeks of treatment.
[Show abstract][Hide abstract] ABSTRACT: Chronic hepatitis C is a global health problem that may cause cirrhosis and progression to hepatocellular carcinoma. Currently available antiviral treatments are moderately effective. Several virological assays are available to help diagnose and manage patients infected with the hepatitis C virus (HCV). These include the anti-HCV antibody assays, measurement of HCV RNA viral load and HCV genotyping. HCV RNA can be assayed by two types of molecular biology-based techniques: target amplification as in polymerase chain reaction methods and signal amplification such as the branched DNA assay. Monitoring of viral kinetics during the early phases of antiviral treatment is crucial in making treatment decisions such as early stopping rules and also in optimizing the length of treatment. The HCV genotype can be determined by several methods. Whatever the method, pretreatment determination allows treatment length and ribavirin dose to be optimized and also offers prognostic information on treatment outcomes as certain genotypes respond more favourably to treatment. Thus, virological assays are indispensable in the diagnosis and management of individuals infected with the HCV.
Liver international: official journal of the International Association for the Study of the Liver 02/2009; 29 Suppl 1(Suppl 1):9-14. DOI:10.1111/j.1478-3231.2008.01926.x · 4.85 Impact Factor
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