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Medicineworld.org: Interferon Treatment For Hepatitis C

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Interferon Treatment For Hepatitis C




A new study on predicting outcomes of standard therapy for hepatitis C virus (HCV) infection observed that many factors impacted responses, including the form of the interferon given. However, for some genotypes of the disease, few of these factors play a role.

The results of this study appear in the July 2007 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). Published by John Wiley & Sons, Inc., Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.



Interferon Treatment For Hepatitis C

Over three million people in the U.S. have chronic HCV infection, which accounts for approximately 40 percent of all chronic liver disease and is the most frequent indication for liver transplants. The current standard of care for HCV is the combination of pegylated interferon alfa (PEG-INF) and ribavarin, but this therapy can be difficult to tolerate. A number of patients have side effects that include fatigue, flu-like symptoms, depression, fever and anemia. These can be severe enough to cause these patients to discontinue therapy.

Led by Lisa I. Backus, of the Center for Quality Management in Public Health located at the Veterans Affairs Palo Alto Health Care System in Palo Alto, CA, scientists conducted a large retrospective study to analyze predictors of sustained virologic response (SVR), or undetectable virus in the blood six months after finishing therapy. For this study, the scientists used a time frame of three months or later to determine an SVR, because a prior study showed that 98 percent of relapses occur within three months of stopping therapy. The study included 5,944 predominantly male patients receiving care at VA medical facilities.

The scientists were able to identify several independent predictors of achieving SVR after therapy. In a number of of the prior trials only a few of these factors were identified, they state. The expanded range of predictors may assist clinicians and patients in more accurately assessing the likelihood of an SVR and thus in making more informed therapy decisions. The results confirmed prior trials that identified low levels of HCV in the blood, absence of cirrhosis, genotype other than genotype 1, and elevated levels of the liver enzyme ALT as independent predictors of SVR. They also confirmed significantly lower SVR rates among African-Americans compared with Caucasians and among patients who had not responded to previous non-pegylated interferon. The results provided new information indicating that the PEG-INF form may affect the likelihood of an SVR: Patients treated with PEG-INF 2A (as opposed to 2B) were 40% more likely to have an SVR. The two forms differ in pharmacokinetic properties, side effects, and method of determining dosage. In addition, the study identified low baseline cholesterol as a negative predictor of an SVR. Low cholesterol may indicate more severe liver disease and subsequent reduced therapy response, the scientists note.

Patients included in the study were 80 percent genotype 1, but few of the significant SVR predictors for this genotype impact the rate for genotype 2 patients and even fewer do so for genotype 3 patients. The results suggest that genotype 2 patients are more likely to respond to HCV therapy than genotype 3 patients, and that SVR predictors differed between these two genotypes, as well as from those for genotype 1.

Our findings serve as a reminder that response rates in routine medical practice may be lower than those in clinical trials, the scientists state. This may be due to the fact that a substantial percentage of the study patients would have been excluded from clinical trials for factors that negatively predict an SVR, and the study showed higher therapy discontinuation rates than in clinical trials, possibly because patients in trials are generally extremely motivated and commonly agree to continue therapy regardless of their response.

The scientists conclude that with the demonstrated efficacy of PEG-INF/ribavarin against HCV, it is increasingly important to understand the predictors of response to this therapy. Just as SVR rates differ substantially by genotype, so too do the significant SVR predictors.


Posted by: Sue    Source




Did you know?
A new study on predicting outcomes of standard therapy for hepatitis C virus (HCV) infection observed that many factors impacted responses, including the form of the interferon given. However, for some genotypes of the disease, few of these factors play a role. The results of this study appear in the July 2007 issue of Hepatology, the official journal of the American Association for the Study of Liver Diseases (AASLD). Published by John Wiley and Sons, Inc., Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

Medicineworld.org: Interferon Treatment For Hepatitis C

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