A Retrospective Evaluation of Veterans with Chronic HCV Treated with Pegylated Interferon and Ribavirin

Abstract

Purpose: The Department of Veterans Affairs estimates that approximately 6-8% of veterans are infected with HCV. Combination pegylated interferon and ribavirin remains the standard of care for treatment. Few reports have evaluated the effect of erythropoietin use during treatment on sustained virologic response (SVR) rate. The aim of this study is to retrospectively assess the SVR rate in Atlanta VA medical center patients treated with peginterferon and ribavirin, and to evaluate the effect of erythropoietin on SVR in genotype 1 patients. Methods: Using the VISTA computer system we performed a search of the pharmacy database of all Atlanta VAMC patients who received peginterferon between January 2000 and December 2007. We included all patients who were treatment naive, chronic hepatitis C infected with genotype 1 or 2/3, and who received at least 12 weeks of peginterferon (alpha 2a or alpha 2b) plus ribavirin. We excluded patients who received < 12 weeks of therapy, or who had incomplete data to allow determination of SVR. Descriptive statistics of the study variables were calculated. Wald Chi-Square method was used to calculate unadjusted odds ratios with 95% confidence intervals. We used logistic regression model to calculate the adjusted odds ratios for SVR with erythropoietin use. Results: A total of 142 patients met the inclusion criteria of the study. The overall SVR rate for patients with genotype 1 was 39%, and for genotype 2/3 was 75%. The SVR rates for the different groups are shown in Table 1. There was no difference in the need for erythropoietin among patients who received peginterferon alpha 2a versus peginterferon alpha 2b (27% vs. 33%, p=0.49). Among patients with genotype 1, patients who received erthyropoietin were twice more likely to have SVR compared to patients who did not receive erythropoietin, but this did not reach statistical significance (OR=2.1, 95% CI= 0.95 to 4.8; P=0.064). This remained not significant after adjusting for age, baseline hemoglobin level and race. Conclusion: SVR rate of treatment naïve Atlanta VA medical center patients treated with peginterferon and ribavirin is comparable to that reported in the literature. There was a trend towards a higher SVR rate in patients with genotype 1 who received erythropoietin, however this was not statistically significant. Future larger studies that evaluate the effect of erythropoietin on SVR are needed.Table: [256] SVR in different treatment groups