Predictive factors of response to peginterferon and ribavirin in tunisians patients with chronic hepatitis c: about 141 cases
##plugins.themes.academic_pro.article.main##
Abstract
Background: The current treatment recommendation for chronic hepatitis c is the combination of peginterferon and ribavirin.
aims: To report our experience in the treatment of chronic hepatitis c and determine the predictive factors of sustained virologic response.
methods: Analysis of consecutive patients treated with peginterferon and ribavirine from 1st January 2000 and 31st December 2009.
results: 141 patients with an average age of 50 years were included. 75 % of the patients were infected by a VHc of genotype 1. 22.6 % of the patients were cirrhotics. 7 % of the patients (n=10) had to stop the treatment because of severe side-effects. A reduction of the dose was indicated for 16 % of the patients (n=23). Among the 117 patients with the end of treatment virologic response, 24 patients (20.5%) relapse during the 6 months after the end of therapy. The sustained virologic response in intention to treat was 66 % (57.9 % in case of genotype 1-4 and 91 % in case of genotype 2-3). In multivariate analysis, 4 independent factors of sustained virologic response were identified: the male gender, a viral genotype not 1, a pre-therapeutic viral load ≤ 600 000 UI / ml and a rapid virologic response.
Conclusion: Approximately two thirds of the patients with chronic hepatitis c achieved a sustained virologic response with peginterferon and ribavirin. Our results are comparable to those of the literature. They will credibly be improved by the introduction of the new antiviral agents.
aims: To report our experience in the treatment of chronic hepatitis c and determine the predictive factors of sustained virologic response.
methods: Analysis of consecutive patients treated with peginterferon and ribavirine from 1st January 2000 and 31st December 2009.
results: 141 patients with an average age of 50 years were included. 75 % of the patients were infected by a VHc of genotype 1. 22.6 % of the patients were cirrhotics. 7 % of the patients (n=10) had to stop the treatment because of severe side-effects. A reduction of the dose was indicated for 16 % of the patients (n=23). Among the 117 patients with the end of treatment virologic response, 24 patients (20.5%) relapse during the 6 months after the end of therapy. The sustained virologic response in intention to treat was 66 % (57.9 % in case of genotype 1-4 and 91 % in case of genotype 2-3). In multivariate analysis, 4 independent factors of sustained virologic response were identified: the male gender, a viral genotype not 1, a pre-therapeutic viral load ≤ 600 000 UI / ml and a rapid virologic response.
Conclusion: Approximately two thirds of the patients with chronic hepatitis c achieved a sustained virologic response with peginterferon and ribavirin. Our results are comparable to those of the literature. They will credibly be improved by the introduction of the new antiviral agents.
Keywords:
chronic hepatitis c, Treatment, Peg interferon, Prognosis##plugins.themes.academic_pro.article.details##
References
- Shepard cW, Finelli L, Alter MJ. Global epidemiology of hepatitis c virus infection. Lancet Infect Dis 2005;5:558-67.
- Bronowicki JP, Barraud H, Peyrin-Biroulet L. Epidemiology and natural history of hepatitis c. Rev Prat 2005;55:607-14
- Manns MP, McHutchison JG, Gordon Sc, et al. Peginterferon alfa- 2b plus ribavirin compared with interferon alpha-2b plus ribavirin for initial treatment of chronic hepatitis c: a randomised trial. Lancet 2001;358:958-65.
- Hadziyannis SJ, Sette H Jr, Morgan TR, et al. Peginterferon alfa- 2a and ribavirin combination therapy in chronic hepatitis c: a randomized study of treatment duration and ribavirin dose. Ann Intern Med 2004;140:346-55.
- Marcellin P. Hepatitis c: The recovery. Gastroenterol clin Biol 2009;33:819-29.
- Sporea I, Sirli R, curescu M, et al. Outcome of antiviral treatment in patients with chronic genotype 1 HcV hepatitis. A retrospective study in 507 patients. J Gastrointestin Liver Dis 2010;19:261-4.
- Belhadj N, Houissa F, Elloumi H, et al. Virological response of Tunisians patients treated by peginterferon plus ribavirin for chronic hepatitis c: a preliminary study. Tunis Med 2008;86:341-5.
- Goh PG, Kim MJ, Kim HJ, et al. Importance of medication adherence to peginterferon-ribavirin combination therapy in patients with chronic hepatitis c. Korean J Gastroenterol 2011;57:294-301.
- Liu cH, Liu cJ, Lin cL, et al. Pegylated interferon-alpha-2a plus ribavirin for treatment-naive Asian patients with hepatitis c virus genotype 1 infection: a multicenter randomized controlled trial. clin Infect Dis 2008;47:1260-9.
- Pattullo V, Heathcote JE, Wong DK. Superior response to pegylated interferon and ribavirin in Asians with chronic hepatitis c. Hepatol Int 2010;4:723-31.
- Tsubota A, Fujise K, Namiki Y, Tada N. Peginterferon and ribavirin treatment for hepatitis c virus infection. World J Gastroenterol 2011;17:419-32.
- Zeuzem S, Pawlotsky JM, Lukasiewicz E, et al. International, multicenter, randomized, controlled study comparing dynamically individualized versus standard treatment in patients with chronic hepatitis c. J Hepatol 2005;43:250-7.
- McHutchison JG, Lawitz EJ, Shiffman ML, et al. For the IDEAL study team peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis c infection. N Engl J Med 2009;361:580- 93.
- Martinot-Peignoux M, Maylin S, Moucari R, et al. Virological response at 4 weeks to predict outcome of hepatitis c treatment with peginterferon and ribavirin. Antivir Ther 2009;13:701-7.
- Hezode c. Traitement sur mesure du génotype 1.Hépato-Gastro 2008;15:7-10.
- Ghany MG, Strader DB, Thomas DL, Seeff LB. AASLD practice guidelines: diagnosis, management, and treatment of hepatitis c: an update. Hepatology 2009;29:1335-74
- EASL clinical Practice Guidelines: Management of hepatitis c virus infection. J Hepatol 2011;55:245-64.
- D'Heygere F, George c, Van Vlierberghe H, et al. Efficacy of interferon-based antiviral therapy in patients with chronic hepatitis c infected with genotype 5: a meta-analysis of two large prospective clinical trials. J Med Virol 2011;83:815-9.
- Ge D, Fellay J, Thompson AJ, et al. Genetic variation in IL28B predicts hepatitis c treatment-induced viral clearance. Nature 2009;461:399-401.
- M. Bourlière, D. Ouzan, M. Rosenheim, et al. Traitement de l'hépatite chronique c par Peginterferon alfa 2a et ribavirine en milieu hospitalier et libéral : résultats des 2101 malades inclus dans l'étude Hepatys. Gastroenterol clin Biol 2007;31:40.
- Patton HM, Patel K, Behling c, et al. The impact of steatosis on disease progression and early sustained treatment response in chronic hepatitis c patients. J hepatol 2004;40:484-90.
- Bruno S, cammà c, Di Marco V, et al. Peginterferon alfa-2b plus ribavirin for naïve patients with genotype 1 chronic hepatitis c: a randomized controlled trial. J Hepatol 2004;41:474-81.
- Afdhal NH, Dieterich DT, Pockros PJ, et al. Epoetin alfa maintains ribavirin dose in HcV-infected patients: a prospective, double-blind, randomized controlled study. Gastroenterology 2004;126:1302-11.
- Kwo PY, Lawitz EJ, Mccone J, et al. Efficacy of boceprevir, an NS3 protease inhibitor, in combination with peginterferon alfa-2b and ribavirin in treatment-naive patients with genotype 1 hepatitis c infection (SPRINT-1): an open-label, randomised, multicentre phase 2 trial. Lancet 2011;376:705-16.
- McHutchison JG, Manns MP, Muir AJ, et al. Telaprevir for previously treated chronic HcV infection. N Engl J Med 2010;362:1292-303.