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Some Genotype 3 Hepatitis C Patients May Require Increased Doses or Longer Treatment: Presented at AASLD

By Maria Bishop

BOSTON, MA -- November 8, 2007 -- Actual treatment outcomes among patients with genotype 2 and 3 hepatitis C virus (HCV) are slightly lower than in those reported in interventional clinical trials, according to research from the Canadian Peginterferon alfa-2b prospective Optimal Weight-based dosing Response (POWeR) program, which was reported here at the 58th Annual Scientific Meeting of the American Association for the Study of Liver Disease (AASLD).

Robert J. Bailey, MD, Gastroenterologist, Royal Alexandra Hospital, and Clinical Professor of Medicine, University of Alberta, Edmonton, Alberta, Canada, author of a POWeR program substudy on genotypes 2 and 3, noted that genotype 3 patients with advanced fibrosis or cirrhosis especially may need increased doses or duration of treatment.

The POWeR program was a large, open-label observational trial conducted in community and academic clinics across Canada between 2002 and 2007 to determine the impact of hepatitis C virus (HCV) genotype, baseline viral load, weight, and fibrosis stage on sustained virological response (SVR) rates. All patients had chronic HCV, were treatment-naïve, and were treated with pegylated interferon alfa-2b (PegIntron) and weight-based ribavirin in a "real-life" observational setting.

This substudy analysed the 38% of POWeR patients with HCV genotype 2 (n = 276) and 3 (n = 389). These patients received pegylated interferon alfa-2b (1.5mcg/kg/wk) plus ribavirin (800 to 1200 mg/d) for 24 weeks, and achieved undetectable HCV ribonucleic acid (RNA) levels at 24 weeks post-treatment.

Overall, SVR rates were significantly higher among genotype 2 than genotype 3 patients (79% vs 72%, P =.01). While the genotype 3 patients had significantly lower end-of-treatment response and SVR rates than genotype 2 patients, both groups had similar, consistently low relapse rates (genotype 3: 6.4%, genotype 2: 7.6%).

Dr. Bailey also noted that predictors of treatment outcome in genotype 3 patients (but not genotype 2 patients) included baseline viral load and Metavir fibrosis score. Liver disease was also a predictor of outcome for genotype 3 patients, with 47% SVR for those patients with cirrhosis (75% in patients with minimal fibrosis).

The researchers concluded that future studies would benefit from separating genotype 2 and 3 patient populations when reporting results in patients with HCV.

This trial was supported by funding from Schering-Plough Canada Inc.


[Presentation title: Response to Peginterferon Alfa-2b + Ribavirin Combination Therapy in Genotype 2 and 3 Patients With Poor Baseline Prognostic Factors: Results of the Canadian POWeR Program. Abstract 246]

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