title: Who is more likely to respond to dual treatment with pegylated-interferon and ribavirin for chronic hepatitis C? A gender-oriented analysis.
abstract: We assessed, in real-life practice, viral, demographic, genetic and metabolic factors influencing the sustained virologic response (SVR), with a gender-oriented analysis, in patients with chronic hepatitis C virus (HCV) treated with pegylated interferon and ribavirin. Six hundred and seventy naïve patients were treated with dual therapy and evaluated by gender and HCV genotype. Associations between baseline variables and SVR were assessed by multivariate logistic regression analysis. Among 362 genotype 1 patients, SVR was achieved in 158 patients (44%), and SVR was independently associated with age less than 50 years (OR 2.12; 95% CI 1.09-4.30; P=0.039) and C/C genotype rs12979860 SNP (OR 2.83; 1.19-6.74; P=0.002) in 163 females, while absence of visceral obesity (OR 2.491; 1.131-5.487; P=0.023), HCV-RNA lower than 400,000 IU/mL (OR 2.66; 1.273-5.558; P=0.009) and C/C genotype rs12979860 SNP (OR 4.969; 2.401-10.283; P<0.001) were independently associated with SVR in 199 males. Combining favourable baseline variables, the probability of obtaining SVR ranged from 27.6% to 84.2% in females, and from 14.3% to 85.7% in males. The rate of SVR was 81.1% in 175 genotype 2 patients, and 69% in 100 genotype 3 patients. Rapid virologic response was the only valid predictor of SVR regardless of other features. In conclusions, in the setting of HCV genotype 1, chronic hepatitis, combining rapid virologic response and predictive factors, which are different for females and males, allows clinicians to single out a group of patients whose likelihood of SVR exceeds 80%. For these patients, triple therapy with first-generation protease inhibitors may be unwarranted.
authors.affiliation: Sezione di Gastroenterologia & Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Di Marco
authors.forename: L
authors.initials: L
authors.lastname: Covolo
authors.forename: V
authors.initials: V
authors.lastname: Calvaruso
authors.forename: M
authors.initials: M
authors.lastname: Levrero
authors.forename: M
authors.initials: M
authors.lastname: Puoti
authors.forename: F
authors.initials: F
authors.lastname: Suter
authors.forename: G B
authors.initials: GB
authors.lastname: Gaeta
authors.forename: C
authors.initials: C
authors.lastname: Ferrari
authors.forename: G
authors.initials: G
authors.lastname: Raimondo
authors.forename: G
authors.initials: G
authors.lastname: Fattovich
authors.forename: T
authors.initials: T
authors.lastname: Santantonio
authors.forename: A
authors.initials: A
authors.lastname: Alberti
authors.forename: R
authors.initials: R
authors.lastname: Bruno
authors.forename: C
authors.initials: C
authors.lastname: Mussini
authors.forename: M
authors.initials: M
authors.lastname: Mondelli
authors.forename: F
authors.initials: F
authors.lastname: Donato
authors.forename: A
authors.initials: A
authors.lastname: Craxì
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D012737:Sex Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D012254:Ribavirin; D007372:Interferons
keywords: HCV-RNA levels; IL28B polymorphisms; chronic hepatitis C; gender; peg-interferon and ribavirin; sustained virologic response