24-Week Treatment is Sufficient for Most Genotype 1 Patients with Rapid Virologi

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24-Week Treatment is Sufficient for Most Genotype 1 Patients with

Rapid Virological Response

Standard therapy for chronic hepatitis C calls for 24 weeks of

pegylated interferon plus ribavirin for patients with genotype 2 or 3

HCV, and 48 weeks for those with harder-to-treat genotype 1. In an

effort to reduce the side effects and cost of treatment, however,

researchers have explored whether certain patients might do well with

shorter courses of therapy. Several studies have shown that rapid

virological response at four weeks predicts long-term sustained

response after the completion of therapy.

In a previous randomized, multinational trial, approximately one-

quarter of genotype 1 patients achieved sustained virological

response (SVR) with 24 weeks of treatment with pegylated interferon

alpha-2a (Pegasys) plus ribavirin.

In a study reported in the May 2006 issue of Hepatology, D.M. Jensen

and colleagues sought to identify which factors were associated with

rapid virological response (RVR) at week 4 (HCV RNA < 50 IU/mL) and

SVR 24 weeks after the completion of therapy.

Results

In the multinational trial, 51 out of 216 genotype 1 patients (24%)

in the 24-week treatment arms achieved RVR.

The SVR rate were nearly five higher among patients with RVR than

among those without (89% vs 19%, respectively).

Patients with baseline HCV RNA less than 200,000 IU/mL (OR 9.7, 95%

CI 4.2-22.5; P < .0001) or 200,000-600,000 IU/mL (OR 3.6, 95% CI 1.5-

9.1; P = .0057) were more likely to achieve RVR than those with HCV

viral loads greater than 600,000 IU/mL.

HCV subtype (1b vs 1a) was also independently associated with RVR

(OR 1.8, 95% CI 0.9-3.7; P = .0954).

RVR (OR 23.7 vs no RVR, 95% CI 9.1-61.7) and baseline HCV RNA less

than 200,000 IU/mL (OR 2.7 vs > 600,000 IU/mL, 95% CI 1.1-6.3; P <

0.026) were significant and independent predictors of SVR in genotype

1 patients treated for 24 weeks.

Conclusion

The authors concluded that patients with genotype 1 HCV who were

treated with pegylated interferon plus ribavirin achieved RVR after

four weeks 24% of the time, which portended an 89% SVR rate after the

completion of therapy.