Sustained virological response rates and durability of the response to interferon-based therapies in hepatitis C patients treated in the clinical setting
Department of Gastroenterology, The Alfred Hospital, Melbourne, Vic., Australia. Journal of Viral Hepatitis
(Impact Factor: 3.91).
05/2006; 13(5):311-5. DOI: 10.1111/j.1365-2893.2005.00685.x
International controlled trials have demonstrated increasing sustained virological response (SVR) rates to interferon-based therapies in hepatitis-C-treated patients. Response rates of 6-20% in the era of interferon monotherapy are compared with 42-82% with pegylated interferon plus ribavirin. The virological durability of the SVR is unknown and the optimal follow-up for these patients is unclear. The aim of our study was to determine SVR rates and the durability of the response to interferon-based therapies in the clinical setting. From our database of 1540 hepatitis C patients, 344 treatment courses of at least 12 weeks duration were identified, including interferon monotherapy (175 patients), interferon plus ribavirin (96 patients) and peginterferon plus ribavirin (73 patients). Interferon monotherapy was associated with an SVR rate of 5% in 103 genotype 1 patients and 25% in 72 genotype 2/3 patients. Response rates were higher (P < 0.001) with interferon plus ribavirin-41% in 34 genotype 1 patients and 73% in 62 genotype 2/3 patients-and with peginterferon plus ribavirin-47% in 47 genotype 1 patients and 79% in 26 genotype 2/3 patients. Of 147 patients with an SVR, 146 (>99%) remained hepatitis C virus PCR negative during a mean 2.3 years (range 0.3-10.3) of follow-up. In conclusion, with advances in therapies, we are achieving higher response rates in hepatitis C patients treated in the clinical setting. We can now expect an SVR in over half of the treated patients. Importantly, the response is durable and medium and long-term follow-up of these patients are of low yield and largely unnecessary.
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Available from: Mostafa Shafiei
- "Last ones by Giannini et al. (2010) conducted large cohort study that evaluated (Giannini et al., 2010; Desmond et al., 2006; Swain and Shiffman, 2004) SVR to pegylated IFN combination with ribavirin in chronic hepatitis C and demonstrated SVR prolonged in 99% of patients (Giannini et al., 2010). Majority of studies reported late viral relapse occurred in first year after SVR (Giannini et al., 2010; Desmond et al., 2006; Swain and Shiffman, 2004). Overall, all these studies emphasize that long-term outcomes (biochemical, histological, clinical and viral) of chronic hepatitis C patients who were treated with pegylated IFN plus ribavirin, is good particularity in those who attained SVR. "
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ABSTRACT: Combination of interferon alfa and ribavirin is the first therapeutic choice in chronic hepatitis C. The aim of this study is to assess long-term outcome of chronic hepatitis C patients treated with pegasys plus ribavirin. We evaluated a cohort of 49 chronic hepatitis C patients who were treated for 48 weeks with pegylated interferon alpha 2a and ribavirin and followed up till week 72 in order to evaluate sustained virological response (SVR) and more than 70% of the patients were followed up over 5 years. In week 72 (the time of achieving SVR), 28 patients were found with SVR (57.14%), 10 were relapse and 11 no response. Long-term viral response (LTR) was defined as remained HCV RNA negativity during long time after SVR. LTR was found in 96.3% of those who had SVR. Late viral relapse occurred within first year after SVR in one patient. Three of 10 patients (30%) who were retreated, obtained SVR. Among the whole patients, 4 had cirrhosis in pre-treatment liver biopsy in which 2 of them got progress to clinical cirrhosis during follow up. No hepatocellular carcinoma occurred during the follow up. The patients who achieved SVR; remained in it chronically and had predictable outcome throughout long-term.
Available from: Solveig Tenckhoff
- "Dialysis patients have an impaired immune system, thus low response to an immune modulating agent as interferon would be expected. Surprisingly, interferon therapy has been shown to be effective with sustained response rates of about almost 50% in dialysis patients [Kokoglu et al., 2006]; [Sporea et al., 2006] compared to only 5–25% in chronic hepatitis C patients without renal insufficiency treated with standard interferon without ribavirin [Desmond et al., 2006]. One explanation for the better response may be the reduction of HCV-RNA viral load in most patients during dialysis [Fabrizi et al., 2003a,b]. "
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ABSTRACT: Hepatitis C infection is a common problem in dialysis units. The prevalence ranges from 3% to more than 50%. Several reports have described a variable reduction of HCV-RNA during hemodialysis treatment sessions. But so far nothing is known about the HCV antigenemia or the kinetics of the reduction of HCV-RNA and HCV antigenemia during these sessions. HCV-RNA was monitored using the VERSANT HCV bDNA assay 3.0 (Bayer Healthcare Diagnostics, Leverkusen, Germany) or the HCV-Monitor TaqMan (Roche Diagnostics). HCV antigenemia was tested by using Ortho-trac-C assay (Ortho Clinical Diagnostics, Neckargemünd, Germany). Kinetics of HCV-RNA were available in 15 dialysis sessions measured by bDNA assay and in 5 dialysis sessions measured by rt-PCR. Quantitative HCV-antigenemia was available in fourteen dialysis sessions. Not only HCV-RNA but as expected also the HCV-antigenemia fell during the dialysis session. However, while the average reduction of HCV-antigen appears steady and linear, the level of HCV-RNA seems to be stable during the first 3 hr of dialysis, and decreases rapidly during the last 2 hr. The results seem to be independent of the HCV-RNA detection method. The different kinetics of HCV RNA and HCV antigen load suggest that there are different mechanisms responsible for the reduction of the HCV antigen and HCV-RNA, respectively. Reduction of viral load during dialysis session indicates a potential benefit of dialysis in case of HCV associated antiviral therapy.
Available from: Anita Palepu
- "The current standard of care for chronic HCV infection is pegylated interferon and ribavirin, which can achieve sustained viral response of approximately 42–82%, depending on genotype. This is a substantial improvement over previous interferon monotherapy response rates of 6–20% (Desmond et al., 2006;National Institutes of Health [NIH], 2002). Unfortunately, the treatment given to persons coinfected with HIV/HCV is less effective (17–83%) at this time, but optimism about therapeutic options is warranted (Chung et al., 2004;Perez-Olmeda et al., 2003;Sulkowski, 2006). "
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ABSTRACT: We examined the association of substance abuse treatment with access to liver specialty care among 231 persons coinfected with HIV and hepatitis C virus (HCV) with a history of alcohol problems who were recruited and followed up in the HIV-Longitudinal Interrelationships of Viruses and Ethanol cohort study from 2001 to 2004. Variables regarding demographics, substance use, health service use, clinical variables, and substance abuse treatment were from a standardized research questionnaire administered biannually. We defined substance abuse treatment services as any of the following in the previous 6 months: 12 weeks in a halfway house or residential facility, 12 visits to a substance abuse counselor or mental health professional, day treatment for at least 30 days, or any participation in a methadone maintenance program. Liver specialty care was defined as a visit to a liver doctor, a hepatologist, or a specialist in treating hepatitis C in the past 6 months. At study entry, most of the 231 subjects (89%, n = 205) had seen a primary care physician, 50% had been exposed to substance abuse treatment, and 50 subjects (22%) had received liver specialty care. An additional 33 subjects (14%) reported receiving liver specialty care during the follow-up period. In the multivariable model, we observed a clinically important although not statistically significant association between having been in substance abuse treatment and receiving liver specialty care (adjusted odds ratio = 1.38; 95% confidence interval = 0.9-2.11). Substance abuse treatment systems should give attention to the need of patients to receive care for prevalent treatable diseases such as HIV/HCV coinfection and facilitate its medical care to improve the quality of care for individuals with substance use disorders. The data illustrate the need for clinical care models that give explicit attention to the coordination of primary health care with addiction and hepatitis C specialty care while providing ongoing support to engage and retain these patients with complex health needs.
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