Interferon-based
Therapy Less Effective for Hepatitis C Patients with Advanced
Liver Fibrosis or Cirrhosis
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| SUMMARY:
People with chronic genotype 1 hepatitis C virus (HCV)
infection who have developed advanced liver fibrosis
or cirrhosis are not as likely as those with less severe
disease to achieve sustained virological response to
pegylated interferon plus ribavirin, according to a
report in the February
2010 issue of Hepatology. Sustained response
rates were similar, however, for people with good early
viral suppression. |
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By
Liz Highleyman
Over years or decades, chronic hepatitis C can progress to severe
liver disease including advanced fibrosis
affecting large areas of the liver, cirrhosis,
and hepatocellular
carcinoma (liver cancer).
Savino
Bruno and colleagues from Italy conducted a study to assess the
safety and efficacy of pegylated
interferon alfa-2a (Pegasys) plus ribavirin in people with
advanced fibrosis enrolled in 3 international randomized clinical
trials.
The analysis included data from 341 chronic hepatitis C patients
with hard-to-treat HCV
genotypes 1 or 4 patients (99 of whom had bridging fibrosis
or cirrhosis) and 1547 patients with genotype
2 or 3 (380 of whom had advanced fibrosis or cirrhosis). Genotype
1 or 4 patients were treated 48 weeks, while those with genotypes
2 or 3 were treated for either 16 or 24 weeks.
The researchers looked at early virological response after starting
treatment and sustained virological
response (SVR), defined as continued undetectable HCV RNA
viral load 24 weeks after completion of therapy.
Results
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SVR
rates progressively decreased as degree of liver damage increased: |
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Genotype
1 or 4 patients: |
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60%
SVR without advanced fibrosis; |
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51%
SVR with bridging fibrosis; |
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33%
SVR with cirrhosis (P = 0.0028 for trend). |
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Genotype
2 or 3 treated for 24 weeks: |
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76%
SVR without advanced fibrosis; |
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61%
SVR with bridging fibrosis; |
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57%
SVR with cirrhosis (P < 0.0001 for trend). |
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Regardless
of genotype, participants without advanced fibrosis were more
likely to experience early response to treatment. |
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Earlier
treatment response was associated with higher SVR rates and
lower relapse rates during post-treatment follow-up. |
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Patients
with similar responses during the first 12 weeks of treatment
had similar SVR and relapse rates, regardless of degree of
fibrosis/cirrhosis. |
Based
on these findings, the study authors concluded, "Compared
with patients with less severe disease, SVR rates are significantly
lower in patients with advanced fibrosis."
However, they added, "irrespective of genotype and degree
of fibrosis, the time to become hepatitis C virus (HCV) RNA undetectable
was the strongest predictor of SVR."
AO Fatebenefratelli e Oftalmico, Milan, Italy; Virginia Commonwealth
University Medical Center, Blacksburg, VA; The Alfred Hospital,
Melbourne, Australia; Auckland Clinical Studies, Auckland, New
Zealand; IST, Mannheim, Germany; Henry Dunant Hospital, Athens,
Greece; Service d'Hepatologie and Centre de Recherches Biologiques
Bichat Beaujon (Inserm CRB3), Hôpital Beaujon, Clichy, France.
4/9/10
Reference
S
Bruno, ML Shiffman, SK Roberts, and others. Efficacy and safety
of peginterferon alfa-2a (40KD) plus ribavirin in hepatitis C
patients with advanced fibrosis and cirrhosis. Hepatology
51(2): 388-397 (Abstract).
February 2010.
