A prospective assessment of an 'a la carte' regimen of PEG-interferon alpha2b an

February 21, 2006

J Viral Hepat. 2006 Mar;13(3):182-9.

A prospective assessment of an 'a la carte' regimen of PEG-interferon

alpha2b and ribavirin combination in patients with chronic hepatitis C using

biochemical markers.

d'Arondel C, Munteanu M, Moussalli J, Thibault V, Naveau S, Simon A, Messous

D, Morra R, Blot C, Poynard T.

Service d'Hepato-Gastroenterologie, Groupe Hospitalier Pitie-Salpetriere,

Universite Paris VI, Paris, France.

Summary. In therapy with standard interferon and ribavirin, five independent

risk factors (RF) were predictive of relapse. The aim was to prospectively

validate an a la carte regimen of pegylated interferon (PEG-IFN) alpha2b 1.5

mug/kg and ribavirin 11 mg/kg [PEG-IFN-ribavirin (PEG-IFN-R)], taking into

account these five risk factors in order to determine whether to continue an

additional 24 weeks of treatment in polymerase chain reaction (PCR) negative

patients after 24 weeks. Treatment was stopped after 24 weeks in PCR

positive patients. The same regimen was continued in PCR negative patients

for an additional 24 weeks if patients had two or more RF. FibroTest and

ActiTest assessed the impact of treatment on the histological features from

baseline to end of follow-up. A total of 96 patients were included; 84

(87.5%) had at least two RF and 12 (12.5%) had no or one RF. A total of 70

patients were sustained virologic response (SVR; 73%), 19 were nonresponders

(20%) and seven were relapsers (7%). The SVR in genotypes 2 or 3 was 85%

(34/40) vs 64% in other genotypes (36/56; P = 0.02). There was a decrease (P

= 0.003) in fibrosis as estimated by FibroTest, from 0.38 +/- 0.03 (mean +/-

SE) at baseline to 0.33 +/- 0.03 at the 12-week follow-up, and a decrease in

activity as estimated by ActiTest, from 0.49 +/- 0.02 to 0.19 +/- 0.03 (P <

0.0001). Improvement in activity was already significant at 12 weeks, even

in virologic nonresponders. This study confirms that an a la carte regimen

which takes into account not only genotype but also baseline viral load,

fibrosis stage, gender and age, is efficient for the PEG-IFN-R combination.

It achieves a 73% SVR and a significant decrease in fibrosis and activity as

estimated by biochemical markers.

PMID: 16475994

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February 21, 2006