Clinical

Longer therapy may benefit subset of patients with HCV

Last Updated: 2006-05-05 17:21:28 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Extended treatment of patients with hepatitis C virus (HCV) type 1 receiving pegylated-interferon-alfa-2a and ribavirin generally leads to no significant difference in outcome, German researchers report. However, a subset of patients may benefit.

As lead author Dr. Thomas Berg told Reuters Health, "our article fits in the new concepts of a more individualized treatment strategy in patients with HCV infection."

To determine whether treatment extension might benefit patients, Dr. Berg of Charite Medical University, Berlin and colleagues compared 48 weeks of treatment with 72 weeks of treatment. The findings are published in the April issue of Gastroenterology.

Two hundred thirty subjects received pegylated-interferon-alfa-2a 180 mcg per week and ribavirin 800 mg per day for 48 weeks. Another group of 225 patients received the same regimen for 72 weeks. All of the subjects were treatment-na�ve.

In the 72-week group, treatment response was seen in 71% patients and a sustained virologic response at 24 weeks was seen in 53%. In the 48-week group, corresponding proportions were 63% and 54%.

Despite the lack of significant difference, patients who were still HCV-RNA positive at week 12 showed significantly higher sustained virologic response rates when treated for 72 rather than 48 weeks (29% versus 17%).

The team concludes that extended therapy should be reserved for patients "with slow virologic response defined as HCV-RNA positive at week 12 but negative at week 24."

These slow responders, continued Dr. Berg, "clearly benefit from extended treatment duration up to 72 weeks."

However, "it has to be kept in mind that even after extended treatment duration, slow virologic responders have a greater risk of relapse after stopping treatment...compared to the rapid responders."

Gastroenterology 2006;130:1086-1097.