Week 4 Rapid Virological Response Predicts Sustained Response to Interferon-based Hepatitis C Treatment

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Week 4 Rapid Virological Response Predicts Sustained Response to

Interferon-based Hepatitis C Treatment

SUMMARY: Rapid virological response (RVR), or undetectable plasma hepatitis C

virus (HCV) RNA at 4 weeks after starting treatment with pegylated interferon

plus ribavirin, has been confirmed as a good indicator of which patients will go

on to achieve sustained virological response (SVR) at 6 months after completion

of therapy, according to a review article published in the June 2010 issue of

Alimentary Pharmacology and Therapeutics.

By Liz Highleyman

Standard treatment for chronic hepatitis C using pegylated interferon (Pegasys

or PegIntron) plus ribavirin produces sustained response -- considered to be a

cure -- about half the time, with HCV genotypes 2 and 3 (treated for 24 week)

showing better response rates than hard-to-treat genotypes 1 or 4 (treated for

48 weeks).

Treatment is expensive and can cause difficult side effects, however, so it is

useful to have an early indicator to enable patients to stop treatment that

likely will not turn out to be successful.

F. Fred Poordad from Cedars-Sinai Medical Center in Los Angeles and colleagues

collected data from previous published clinical trial reports in order to

evaluate the predictive value of RVR as an indicator of SVR and viral relapse.

Results

Data supported a 24-week regimen for HCV genotype 1 patients who achieved RVR.

The positive predictive value -- or how often RVR accurately predicted SVR --

was 77.8% for patients treated for 24 weeks versus 85.7% for those treated for

48 weeks, not a significant difference.

However, lack of RVR among genotype 1 patients " should not be viewed as a

criterion for extending treatment duration beyond 48 weeks. "

Negative predictive values -- or how often lack of RVR predicted failure to

achieve SVR -- were 60.9% for genotype 1 patients treated for 48 weeks and 52.7%

for those treated for 72 weeks, not a significant improvement with longer

therapy.

Among people with HCV genotypes 2 or 3, RVR also had a high positive predictive

value.

Negative predictive value, however, varied according to treatment duration,

indicating that a 24-week regimen is warranted for genotype 2 or 3 patients who

did not achieve RVR.

Based on these findings, the study authors concluded, " The present analysis

confirms RVR as a strong predictor of SVR that can be used to tailor treatment

duration, but which also should be appreciated in the context of treatment

duration and regimen. "

Investigator affiliation: Hepatology and Liver Transplantation, Cedars-Sinai

Medical Center, Los Angeles, CA.

9/3/10

Reference

FF Poordad. Review article: the role of rapid virological response in

determining treatment duration for chronic hepatitis C. Alimentary Pharmacology

and Therapeutics 31(12): 1251-1267 (Abstract). June 2010.