Regimens For Treatment Of Chronic Hepatitis Research Articles

High effectiveness of peginterferon alfa-2a plus ribavirin therapy in Korean patients with chronic hepatitis C in clinical practice

Background/AimsIdentifying the impact of a patient's ethnicity on treatment responses in clinical practice may assist in providing individualized treatment regimens for chronic hepatitis C (CHC). The effectiveness of standard peginterferon plus ribavirin therapy and the need for triple combination therapy with protease inhibitors in Koreans remain matters of debate. These issues were investigated in the present study.MethodsThe clinical data of 272 treatment-naïve Korean CHC patients who were treated in a community-based clinical trial (Clinical Trial group; n=51) and in clinical practice (Cohort group; n=221), were analyzed and compared. All were treated with standard protocols of peginterferon alfa-2a plus ribavirin therapy.ResultsFor patients with hepatitis C virus (HCV) genotype 1, the sustained virological response (SVR) rates in the Clinical Trial and Cohort groups were 81% (21/26) and 55% (58/106), respectively, by intention-to-treat (ITT) analysis (P=0.02), and 100% (13/13) and 80% (32/40), respectively, in treatment-adherent patients (P=0.18). For patients with HCV genotype 2, the SVR rates in these two groups were 96% (24/25) and 88% (101/115), respectively, by ITT analysis (P=0.31). Adherence and treatment duration were independent predictors of SVR for genotypes 1 and 2, respectively (P<0.01 for each). Korean patients with CHC achieved high SVR rates with peginterferon alfa-2a plus ribavirin in both the clinical trial and clinical practice settings.ConclusionsMeasures to raise adherence to standard therapy in clinical practice may improve the SVR rates in these patients as effectively as adding protease inhibitors, thus obviating the need for the latter.

Individualization of antiviral treatment regimens for chronic hepatitis C

The treatment of patients with chronic hepatitis C has rapidly evolved in the past 10 years. The introduction of ribavirin and, more recently, its combination with pegylated interferon represent two landmark changes in improving the treatment efficacy. Overall, sustained virological response at present can be expected in 43-46% of patients infected with genotype 1 and 75-80% in genotype 2 or 3 infection. In addition, factors associated with a lower or greater chance of response to treatment have now been identified, thus providing a basis for modifying current therapy according to the needs of different patient groups. Accumulating evidence demonstrates that individualized treatment regimens, according to the timing of treatment-induced viral clearance, provide a safe and cost-effective approach, as well as an improvement in treatment efficacy.