Optimal Duration of Pegylated Interferon Plus Ribavirin Therapy for Chronic Hepatitis C Genotype 3 Patients who do not Achieve Rapid Virological Response.
OBJECTIVE
Chronic hepatitis C (CHC) genotype-3 (G-3) patients treated with standard 24-week pegylated interferon plus ribavirin(PEG-RBV) therapy achieve sustained virological response(SVR) rate of 69-82%. Patients who do not achieve rapid virological response(RVR) have lower SVR rate. Data regarding optimal management of this subgroup is scarce. We aimed to determine the most appropriate treatment duration in CHC G-3 patients who do not achieve RVR.


METHODS
Treatment naïve CHC G-3 patients treated with PEG-RBV therapy were included in this retrospective analysis. Patients with cirrhosis were excluded. RVR was assessed in all patients beyond the year 2007. RVR non-achievers were advised extended treatment beyond 24 weeks.


RESULTS
Of the total 685 patients started on treatment, 646 completed treatment (mean age 39.1 ± 12 years, 68.3% males). In the pre-'RVR assessment' period (2004-2006), SVR with standard 24 week therapy was 72.3% (112/155). In post-'RVR assessment' period (2007-2013), 75.8% (402/530) patients achieved RVR; and 91.5% (368/402) of these achieved SVR with standard 24 weeks therapy. Among RVR non-achievers (n = 128), 51 patients opted for extended 36 week therapy, 12 for 48 week therapy, while 65 stopped therapy at 24 weeks. Choice of treatment duration was dependent entirely on the affordability of the patient. SVR with extended therapy (36/48 weeks) was significantly higher than standard 24 week therapy in RVR non-achievers (82.5% vs. 52.3%; P = 0.003). However, SVR rate in 36 week group was not significantly different from 48 week group (84.3% vs. 75%; P = 0.425]. On multivariate analysis, duration of treatment (36/48 week vs. 24 week; P < 0.001) was significantly associated with SVR.


CONCLUSIONS
SVR rates in CHC G-3 patients treated with PEG-RBV in northern India were comparable to western data. Standard 24 week therapy is adequate for RVR-achievers. However, in RVR non-achievers, extended 36 week therapy significantly improves SVR, while further extension to 48 week does not provide any additional advantage.
Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Ajit
A
Sood
Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Vandana
V
Midha
Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Omesh
O
Goyal
36 weeks therapy; ALT, alanine aminotransferase; BMI, Body mass index; CHC, Chronic hepatitis C; EVR, early virological response; HBV, hepatitis B virus; HCV, Hepatitis C virus; HIV, Human Immunodeficiency virus; PTI, prothrombin time index; RVR non-achievers; SVR, sustained virologic response; cEVR, Complete EVR; chronic hepatitis C; pegylated interferon; ribavirin