title: New proposal for response-guided peg-interferon-plus-ribavirin combination therapy for chronic hepatitis C virus genotype 2 infection.
abstract: This study aimed to determine the most suitable duration of pegylated-interferon (Peg-IFN)-plus-ribavirin combination therapy in patients infected with hepatitis C virus (HCV) genotype 2 who had not achieved rapid virological response (serum HCV RNA disappearance after 4 weeks of therapy). HCV genotype 2 patients (n = 182) with a high viral load received >80% of the standard Peg-IFN-plus-ribavirin dose for at least 24 weeks, and their final virological responses were studied. Patients were classified into "rapid virological response" and "non-rapid virological response" groups. The non-rapid virological response group was further divided into a "virological response at 8 weeks" (serum HCV RNA disappearance after 8 weeks of therapy) and a "non-virological response at 8 weeks" group. Factors related to rapid virological response and optimal therapy duration in the non-rapid virological response group were evaluated. Multivariate logistic regression analysis showed that subtype HCV genotype 2a (P = 0.0015) and low concentration of pretreatment serum HCV RNA (P = 0.0058) were independent factors in a rapid virological response. In the virological response at 8 weeks group, the sustained virological response rate after 24 weeks of therapy was significantly lower than after 36 weeks (P = 0.044) or after 48 weeks (P = 0.006), and was similar for 36- and 48-weeks. The cost for achieving (CAS) one sustained virological response was lowest with 36-week therapy. Prolongation of Peg-IFN-plus-ribavirin combination therapy to 36 weeks is suitable for achieving virological response at 8 weeks, given the high, sustained virological response rate and cost benefit.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Jikei University School of Medicine Katsushika Medical Center, Katsushika-Ku, Tokyo, Japan. hiroshiabe222@aol.com
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Abe
authors.forename: Yuta
authors.initials: Y
authors.lastname: Aida
authors.forename: Haruya
authors.initials: H
authors.lastname: Ishiguro
authors.forename: Kai
authors.initials: K
authors.lastname: Yoshizawa
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Seki
authors.forename: Tamihiro
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Munenori
authors.initials: M
authors.lastname: Itagaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sutoh
authors.forename: Makiko
authors.initials: M
authors.lastname: Ika
authors.forename: Keizo
authors.initials: K
authors.lastname: Kato
authors.forename: Noritomo
authors.initials: N
authors.lastname: Shimada
authors.forename: Akihito
authors.initials: A
authors.lastname: Tsubota
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Aizawa
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D016903:Drug Monitoring / Q000379:methods*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000145:classification / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D012367:RNA, Viral / Q000097:blood; D012254:Ribavirin / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; C571406:PEG-IFN-SA; D012367:RNA, Viral; D011092:Polyethylene Glycols; D012254:Ribavirin
keywords: HCV genotype 2; cost per one patient achieving sustained virological response (CAS); duration of therapy; response-guided therapy; virological response