Chronic Hepatitis C Virus Management: 2000-2005 Update

[Guest guest]

From The ls of Pharmacotherapy

Chronic Hepatitis C Virus Management: 2000-2005 Update

Posted 02/09/2006

A. ; D. Shafran

Abstract and Introduction

Abstract

Objective: To review recent advances that have significantly changed the

management of chronic hepatitis C virus (HCV) infection.

Data Sources: A MEDLINE search (2000-July 2005) was conducted using key

words such as hepatitis C, interferon, pegylated interferon, and therapy.

Study Selection and Data Extraction: All articles pertaining to treatment of

chronic HCV infection were identified. Studies evaluating HCV treatment in

treatment-naive patients were considered for this review.

Data Synthesis: Over the past several years, response to treatment for

chronic HCV infection has significantly improved with the use of pegylated

interferon and ribavirin therapy. Treatment response is influenced by HCV

genotype and viral load, as well as patient-related factors, including

adherence.

Conclusions: Treatment of chronic HCV infection has improved, with overall

response rates of approximately 55%. Identification and management of common

adverse effects is important in maximizing adherence and response to

therapy. Studies are needed to further delineate the optimum treatment of

chronic HCV infection in specific patient populations.

Introduction

Hepatitis C virus (HCV) infection is the most common chronic blood-borne

infection, with an estimated 170 million people infected worldwide.[1]

Approximately 20% of patients with chronic HCV infection progress to

cirrhosis after an average of 20 years, and 5% will develop hepatocellular

carcinoma.[2-4] In the US, approximately 3 million people are chronically

infected, and HCV infection is the leading cause of liver

transplantation.[1,5] Mortality due to chronic HCV infection is expected to

increase two- to threefold over the next 10-20 years. Thus, HCV infection is

considered a major public health problem.

The primary goal of therapy for chronic HCV infection is viral eradication.

This is known as a sustained virologic response (SVR) and is defined as the

absence of detectable HCV RNA in the serum using a sensitive qualitative HCV

RNA assay 6 months following the completion of therapy.[6-8] Studies of

combination therapy with interferon (IFN) alfa and ribavirin demonstrated

SVRs of approximately 40%.[9-11] In recent years, there have been

significant advances in the management of chronic HCV infection, including

the introduction of pegylated IFN (PEG-IFN). Two forms of PEG-IFN, alfa-2a

and alfa-2b, have been approved for HCV treatment. Although they differ in

their pharmacologic properties, both possess an increased and sustained

duration of activity due to longer serum half-lives than conventional IFN

alfa.[12-14] PEG-IFN alfa-2b has a larger volume of distribution and faster

clearance than PEG-IFN alfa-2a; plasma levels are dependent on body

weight.[12,14] For this reason, PEG-IFN alfa-2b is administered at a dose of

1.5 µg/kg subcutaneously once weekly (when used in combination with

ribavirin), whereas PEG-IFN alfa-2a is given at a fixed dose of 180 µg/wk

subcutaneously. PEG-IFN alfa-2b is partially renally cleared; therefore,

dosage adjustments are recommended by the manufacturer in patients with a

creatinine clearance less than 50 mL/min.[15]

Overall SVRs of 25-40% were achieved in PEG-IFN monotherapy studies.[16-19]

Combination therapy with PEG-IFN and ribavirin yields higher response rates,

with eradication of the virus in more than half of treated patients.[20-22]

HCV genotype has been shown to be the single most important predictor of

treatment response. There are 6 major HCV genotypes, with genotype 1 the

most common in the US (70% of patients).[23] The prevalence of genotypes 2

and 3 is approximately 5% and 20%, respectively. Genotype 4 has a low

prevalence in the US (<1%) and is mainly found in the Middle East and North

Africa. Genotypes 5 and 6 are rarely seen outside isolated geographic areas

in South Africa (genotype 5) and Southeast Asia (genotype 6).[24]

In this article, we review recently published literature on the management

of chronic HCV infection in treatment-naïve patients. A computerized search

of MEDLINE was performed (2000-July 2005) using the following key words:

hepatitis C, interferon, pegylated interferon, and therapy. All relevant

articles that focused on antiviral treatment of chronic HCV infection in

adults were included. We excluded data on treatment of acute HCV infection,

HCV reinfection of transplanted livers, and coinfection with HIV or

hepatitis B virus.

FULL TEXT: http://www.medscape.com/viewarticle/521823?src=mp

_________________________________________________________________

Express yourself instantly with MSN Messenger! Download today - it's FREE!

http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/

[Guest guest]

From The ls of Pharmacotherapy

Chronic Hepatitis C Virus Management: 2000-2005 Update

Posted 02/09/2006

A. ; D. Shafran

Abstract and Introduction

Abstract

Objective: To review recent advances that have significantly changed the

management of chronic hepatitis C virus (HCV) infection.

Data Sources: A MEDLINE search (2000-July 2005) was conducted using key

words such as hepatitis C, interferon, pegylated interferon, and therapy.

Study Selection and Data Extraction: All articles pertaining to treatment of

chronic HCV infection were identified. Studies evaluating HCV treatment in

treatment-naive patients were considered for this review.

Data Synthesis: Over the past several years, response to treatment for

chronic HCV infection has significantly improved with the use of pegylated

interferon and ribavirin therapy. Treatment response is influenced by HCV

genotype and viral load, as well as patient-related factors, including

adherence.

Conclusions: Treatment of chronic HCV infection has improved, with overall

response rates of approximately 55%. Identification and management of common

adverse effects is important in maximizing adherence and response to

therapy. Studies are needed to further delineate the optimum treatment of

chronic HCV infection in specific patient populations.

Introduction

Hepatitis C virus (HCV) infection is the most common chronic blood-borne

infection, with an estimated 170 million people infected worldwide.[1]

Approximately 20% of patients with chronic HCV infection progress to

cirrhosis after an average of 20 years, and 5% will develop hepatocellular

carcinoma.[2-4] In the US, approximately 3 million people are chronically

infected, and HCV infection is the leading cause of liver

transplantation.[1,5] Mortality due to chronic HCV infection is expected to

increase two- to threefold over the next 10-20 years. Thus, HCV infection is

considered a major public health problem.

The primary goal of therapy for chronic HCV infection is viral eradication.

This is known as a sustained virologic response (SVR) and is defined as the

absence of detectable HCV RNA in the serum using a sensitive qualitative HCV

RNA assay 6 months following the completion of therapy.[6-8] Studies of

combination therapy with interferon (IFN) alfa and ribavirin demonstrated

SVRs of approximately 40%.[9-11] In recent years, there have been

significant advances in the management of chronic HCV infection, including

the introduction of pegylated IFN (PEG-IFN). Two forms of PEG-IFN, alfa-2a

and alfa-2b, have been approved for HCV treatment. Although they differ in

their pharmacologic properties, both possess an increased and sustained

duration of activity due to longer serum half-lives than conventional IFN

alfa.[12-14] PEG-IFN alfa-2b has a larger volume of distribution and faster

clearance than PEG-IFN alfa-2a; plasma levels are dependent on body

weight.[12,14] For this reason, PEG-IFN alfa-2b is administered at a dose of

1.5 µg/kg subcutaneously once weekly (when used in combination with

ribavirin), whereas PEG-IFN alfa-2a is given at a fixed dose of 180 µg/wk

subcutaneously. PEG-IFN alfa-2b is partially renally cleared; therefore,

dosage adjustments are recommended by the manufacturer in patients with a

creatinine clearance less than 50 mL/min.[15]

Overall SVRs of 25-40% were achieved in PEG-IFN monotherapy studies.[16-19]

Combination therapy with PEG-IFN and ribavirin yields higher response rates,

with eradication of the virus in more than half of treated patients.[20-22]

HCV genotype has been shown to be the single most important predictor of

treatment response. There are 6 major HCV genotypes, with genotype 1 the

most common in the US (70% of patients).[23] The prevalence of genotypes 2

and 3 is approximately 5% and 20%, respectively. Genotype 4 has a low

prevalence in the US (<1%) and is mainly found in the Middle East and North

Africa. Genotypes 5 and 6 are rarely seen outside isolated geographic areas

in South Africa (genotype 5) and Southeast Asia (genotype 6).[24]

In this article, we review recently published literature on the management

of chronic HCV infection in treatment-naïve patients. A computerized search

of MEDLINE was performed (2000-July 2005) using the following key words:

hepatitis C, interferon, pegylated interferon, and therapy. All relevant

articles that focused on antiviral treatment of chronic HCV infection in

adults were included. We excluded data on treatment of acute HCV infection,

HCV reinfection of transplanted livers, and coinfection with HIV or

hepatitis B virus.

FULL TEXT: http://www.medscape.com/viewarticle/521823?src=mp

_________________________________________________________________

Express yourself instantly with MSN Messenger! Download today - it's FREE!

http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/

[Guest guest]

From The ls of Pharmacotherapy

Chronic Hepatitis C Virus Management: 2000-2005 Update

Posted 02/09/2006

A. ; D. Shafran

Abstract and Introduction

Abstract

Objective: To review recent advances that have significantly changed the

management of chronic hepatitis C virus (HCV) infection.

Data Sources: A MEDLINE search (2000-July 2005) was conducted using key

words such as hepatitis C, interferon, pegylated interferon, and therapy.

Study Selection and Data Extraction: All articles pertaining to treatment of

chronic HCV infection were identified. Studies evaluating HCV treatment in

treatment-naive patients were considered for this review.

Data Synthesis: Over the past several years, response to treatment for

chronic HCV infection has significantly improved with the use of pegylated

interferon and ribavirin therapy. Treatment response is influenced by HCV

genotype and viral load, as well as patient-related factors, including

adherence.

Conclusions: Treatment of chronic HCV infection has improved, with overall

response rates of approximately 55%. Identification and management of common

adverse effects is important in maximizing adherence and response to

therapy. Studies are needed to further delineate the optimum treatment of

chronic HCV infection in specific patient populations.

Introduction

Hepatitis C virus (HCV) infection is the most common chronic blood-borne

infection, with an estimated 170 million people infected worldwide.[1]

Approximately 20% of patients with chronic HCV infection progress to

cirrhosis after an average of 20 years, and 5% will develop hepatocellular

carcinoma.[2-4] In the US, approximately 3 million people are chronically

infected, and HCV infection is the leading cause of liver

transplantation.[1,5] Mortality due to chronic HCV infection is expected to

increase two- to threefold over the next 10-20 years. Thus, HCV infection is

considered a major public health problem.

The primary goal of therapy for chronic HCV infection is viral eradication.

This is known as a sustained virologic response (SVR) and is defined as the

absence of detectable HCV RNA in the serum using a sensitive qualitative HCV

RNA assay 6 months following the completion of therapy.[6-8] Studies of

combination therapy with interferon (IFN) alfa and ribavirin demonstrated

SVRs of approximately 40%.[9-11] In recent years, there have been

significant advances in the management of chronic HCV infection, including

the introduction of pegylated IFN (PEG-IFN). Two forms of PEG-IFN, alfa-2a

and alfa-2b, have been approved for HCV treatment. Although they differ in

their pharmacologic properties, both possess an increased and sustained

duration of activity due to longer serum half-lives than conventional IFN

alfa.[12-14] PEG-IFN alfa-2b has a larger volume of distribution and faster

clearance than PEG-IFN alfa-2a; plasma levels are dependent on body

weight.[12,14] For this reason, PEG-IFN alfa-2b is administered at a dose of

1.5 µg/kg subcutaneously once weekly (when used in combination with

ribavirin), whereas PEG-IFN alfa-2a is given at a fixed dose of 180 µg/wk

subcutaneously. PEG-IFN alfa-2b is partially renally cleared; therefore,

dosage adjustments are recommended by the manufacturer in patients with a

creatinine clearance less than 50 mL/min.[15]

Overall SVRs of 25-40% were achieved in PEG-IFN monotherapy studies.[16-19]

Combination therapy with PEG-IFN and ribavirin yields higher response rates,

with eradication of the virus in more than half of treated patients.[20-22]

HCV genotype has been shown to be the single most important predictor of

treatment response. There are 6 major HCV genotypes, with genotype 1 the

most common in the US (70% of patients).[23] The prevalence of genotypes 2

and 3 is approximately 5% and 20%, respectively. Genotype 4 has a low

prevalence in the US (<1%) and is mainly found in the Middle East and North

Africa. Genotypes 5 and 6 are rarely seen outside isolated geographic areas

in South Africa (genotype 5) and Southeast Asia (genotype 6).[24]

In this article, we review recently published literature on the management

of chronic HCV infection in treatment-naïve patients. A computerized search

of MEDLINE was performed (2000-July 2005) using the following key words:

hepatitis C, interferon, pegylated interferon, and therapy. All relevant

articles that focused on antiviral treatment of chronic HCV infection in

adults were included. We excluded data on treatment of acute HCV infection,

HCV reinfection of transplanted livers, and coinfection with HIV or

hepatitis B virus.

FULL TEXT: http://www.medscape.com/viewarticle/521823?src=mp

_________________________________________________________________

Express yourself instantly with MSN Messenger! Download today - it's FREE!

http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/

[Guest guest]

From The ls of Pharmacotherapy

Chronic Hepatitis C Virus Management: 2000-2005 Update

Posted 02/09/2006

A. ; D. Shafran

Abstract and Introduction

Abstract

Objective: To review recent advances that have significantly changed the

management of chronic hepatitis C virus (HCV) infection.

Data Sources: A MEDLINE search (2000-July 2005) was conducted using key

words such as hepatitis C, interferon, pegylated interferon, and therapy.

Study Selection and Data Extraction: All articles pertaining to treatment of

chronic HCV infection were identified. Studies evaluating HCV treatment in

treatment-naive patients were considered for this review.

Data Synthesis: Over the past several years, response to treatment for

chronic HCV infection has significantly improved with the use of pegylated

interferon and ribavirin therapy. Treatment response is influenced by HCV

genotype and viral load, as well as patient-related factors, including

adherence.

Conclusions: Treatment of chronic HCV infection has improved, with overall

response rates of approximately 55%. Identification and management of common

adverse effects is important in maximizing adherence and response to

therapy. Studies are needed to further delineate the optimum treatment of

chronic HCV infection in specific patient populations.

Introduction

Hepatitis C virus (HCV) infection is the most common chronic blood-borne

infection, with an estimated 170 million people infected worldwide.[1]

Approximately 20% of patients with chronic HCV infection progress to

cirrhosis after an average of 20 years, and 5% will develop hepatocellular

carcinoma.[2-4] In the US, approximately 3 million people are chronically

infected, and HCV infection is the leading cause of liver

transplantation.[1,5] Mortality due to chronic HCV infection is expected to

increase two- to threefold over the next 10-20 years. Thus, HCV infection is

considered a major public health problem.

The primary goal of therapy for chronic HCV infection is viral eradication.

This is known as a sustained virologic response (SVR) and is defined as the

absence of detectable HCV RNA in the serum using a sensitive qualitative HCV

RNA assay 6 months following the completion of therapy.[6-8] Studies of

combination therapy with interferon (IFN) alfa and ribavirin demonstrated

SVRs of approximately 40%.[9-11] In recent years, there have been

significant advances in the management of chronic HCV infection, including

the introduction of pegylated IFN (PEG-IFN). Two forms of PEG-IFN, alfa-2a

and alfa-2b, have been approved for HCV treatment. Although they differ in

their pharmacologic properties, both possess an increased and sustained

duration of activity due to longer serum half-lives than conventional IFN

alfa.[12-14] PEG-IFN alfa-2b has a larger volume of distribution and faster

clearance than PEG-IFN alfa-2a; plasma levels are dependent on body

weight.[12,14] For this reason, PEG-IFN alfa-2b is administered at a dose of

1.5 µg/kg subcutaneously once weekly (when used in combination with

ribavirin), whereas PEG-IFN alfa-2a is given at a fixed dose of 180 µg/wk

subcutaneously. PEG-IFN alfa-2b is partially renally cleared; therefore,

dosage adjustments are recommended by the manufacturer in patients with a

creatinine clearance less than 50 mL/min.[15]

Overall SVRs of 25-40% were achieved in PEG-IFN monotherapy studies.[16-19]

Combination therapy with PEG-IFN and ribavirin yields higher response rates,

with eradication of the virus in more than half of treated patients.[20-22]

HCV genotype has been shown to be the single most important predictor of

treatment response. There are 6 major HCV genotypes, with genotype 1 the

most common in the US (70% of patients).[23] The prevalence of genotypes 2

and 3 is approximately 5% and 20%, respectively. Genotype 4 has a low

prevalence in the US (<1%) and is mainly found in the Middle East and North

Africa. Genotypes 5 and 6 are rarely seen outside isolated geographic areas

in South Africa (genotype 5) and Southeast Asia (genotype 6).[24]

In this article, we review recently published literature on the management

of chronic HCV infection in treatment-naïve patients. A computerized search

of MEDLINE was performed (2000-July 2005) using the following key words:

hepatitis C, interferon, pegylated interferon, and therapy. All relevant

articles that focused on antiviral treatment of chronic HCV infection in

adults were included. We excluded data on treatment of acute HCV infection,

HCV reinfection of transplanted livers, and coinfection with HIV or

hepatitis B virus.

FULL TEXT: http://www.medscape.com/viewarticle/521823?src=mp

_________________________________________________________________

Express yourself instantly with MSN Messenger! Download today - it's FREE!

http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/