Shorter Therapy Effective for Genotypes 2 and 3
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Genotypes 2 and 3 are much more responsive to current interferon combination therapies. This report details studies that show a shorter course of treatment might be just as effective as longer courses.
Researchers continue to refine treatment protocols for HCV patients.
Short Therapy Regimens Effective for Hepatitis C Virus Genotype 2 and 3:
Presented at AASLD
By Crystal Phend
SAN FRANCISCO, CA — November 21, 2005 — Hepatitis C infected patients with genotype 2 or 3 may be able to shorten their course of therapy without losing effectiveness, according to a study presented here at the American Association for the Study of Liver Diseases annual meeting (AASLD).
According to presenter Olav Dalgard, MD, PhD, Infectious Diseases Specialist, Aker University Hospital, Oslo, Norway, the viral response at week 4 may be a guide to considering shorter treatment.
Two recently published studies found shorter therapy to be effective, but left unanswered which subgroups are less likely to respond, that is, dosing and baseline predictive factors, Dr. Dalgard said during a presentation on November 14th.
To answer those questions, his group used pooled data from two studies involving a total 403 adults with hepatitis C genotype 2 or 3 who were treatment naïve.
The Norwegian study dosed pegylated interferon alpha-2b at 1.5 mcg/kg once weekly with 800 to 1,200 mg of ribavirin for 14 weeks or for 24 weeks if patients had not achieved a response by week 14.
The Italian study followed the same schedule as the Norwegian study, with a slightly lower 1.0 mcg/kg pegylated interferon alpha-2b dose for 12 weeks or 24 weeks for non-responders at week 12.
Patients were tested for virus RNA levels at weeks 4, 12 or 14 and 24.
The 313 patients who achieved a sustained viral response (SVR) were analyzed by subgroup.
Results show a significant difference in the percentage of patients who achieved SVR according to fibrosis score ( 83% with a score of 0 to 2 vs. 67% with a score 3 to 4).
Patients with genotype 2 were significantly more likely to respond than those with genotype 3 (81% vs. 73%).
“In non-rapid viral response patients, 24 weeks of therapy for HCV 2 patients may be satisfactory whereas longer courses should be considered for genotype 3,” Dr. Dalgard said.
Patients who had a rapid viral response by week 4 were significantly more likely to have a sustained viral response than those who did not (85% vs. 62%).
Those who had a rapid viral response at week 4 were significantly more likely to have a low fibrosis score (70% 0 to 2 vs. 56% 3 to 4) and to be at the higher 1.5 dose of peginterferon (78% vs. 64%).
Multivariate analysis found that the response at 4 weeks was a significant predictor of sustained response, although genotype, baseline viral load and treatment regimen were not.
Relapse could not be predicted by any baseline characteristic.
“In HCV 2 or 3, viral response at week 4 may reliably guide treatment duration as the majority of rapid responders may safely receive shorter courses of therapy without compromising SVR,” the researchers concluded.
[Presentation title: Short-Term Treatment Duration for HCV-2 and HCV-3 Infected Patients with Chronic Hepatitis. Abstract 849]
