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Hepatitis C and Decompensated Cirrhosis Improve With Combination Therapy, Individualized Approach: Presented at AASLD
By Maria Bishop
BOSTON, MA -- November 9, 2007 -- Identifying patients most likely to attain a sustained virologic response (SVR) requires an individualised approach in the treatment of patients with chronic hepatitis C and decompensated cirrhosis, Italian researchers reported here at the 58th Annual Scientific Meeting of the American Association for the Study of Liver Disease (AASLD).
Patients infected with hepatitis C virus (HCV) genotype 2 who also have decompensated cirrhosis, for example, can still be treated successfully with pegylated interferon alfa-2b plus oral ribavirin, noted lead author Angelo Iacobellis, MD, Executive Physician, Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy. Accounting for viral genotype and early viral kinetics are the major pieces of the treatment puzzle.
Dr. Iacobellis and colleagues set out to determine whether rapid virologic response could predict SVR in patients with decompensated cirrhosis naïve to previous combined antiviral therapy. They analysed data from 94 patients with cirrhosis (96% Child-Pugh class B) who underwent treatment with peginterferon alfa-2b (1.5 mcg/kg/wk) and oral ribavirin (800 or 1000 mg) for either 24 weeks (genotypes 1 and 4, n = 50) or 48 weeks (genotypes 2 and 3, n = 44). The mean patient age was 62.4 ± 7 years.
Overall, an SVR was achieved in 34 patients (36.2%) -- 8 of them with genotype 1 or 4, and 26 with genotype 2 and 3 (P <.01).
A rapid virologic response was recorded at treatment week 4 of 24 weeks follow-up: 34 patients cleared HCV, 10 with genotype 1 and 4, and 24 with genotypes 2 and 3.
Four patients who were rapid responders had to stop therapy early due to serious adverse events. Of the 34 patients who achieved rapid virologic response, 24 (70.6%) achieved SVR at a significant difference between genotypes: 6 of 10 genotype 1 and 4 patients (60%), and 18 of 24 genotypes 2 and 3 (75%) (P <.01).
Twenty-eight (82.3%) of all rapid responders who achieved SVR had a pre-treatment viral load of 600,000 UI/mL or less.
In patients who are not rapid responders, and who are in the more difficult-to-treat genotypes 1 and 4, 48 weeks of therapy appears insufficient to attain optimal SVR rates, Dr. Iacobellis stated.
The researchers concluded that decompensated patients with HCV-related liver cirrhosis achieve on-treatment viral clearance at different times based on genotype. Achieving the rapid virologic response status may guide a physician's determination of treatment length.
The present study further supports the feasibility of antiviral treatment with pegylated interferon alfa-2b and ribavirin.
[Presentation title: Clinical Relevance of Rapid Virological Response (RVR) in Decompensated HCV-Related Cirrhosis Treated with PEG-Interferon and Ribavirin. Abstract 282]
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