Effectiveness of treatment with pegylated interferon and ribavirin in an unselected population of patients with chronic hepatitis C: A Danish nationwide cohort study

Abstract

BackgroundThe effect of peginterferon and ribavirin treatment on chronic hepatitis C virus (HCV) infection has been established in several controlled clinical studies. However, the effectiveness of treatment and predictors of treatment success in routine clinical practice remains to be established. Our aim was to estimate the effectiveness of peginterferon and ribavirin treatment in unselected HCV patients handled in routine clinical practice. The endpoint was sustained virological response (SVR), determined by the absence of HCV RNA 24 weeks after the end of treatment.MethodsWe determined the proportion of SVR in a nationwide, population-based cohort of 432 patients with chronic HCV infection who were starting treatment, and analyzed the impact of known covariates on SVR by using a logistic regression analysis.ResultsThe majority of treated patients had genotype 1 (133 patients) and genotype 2/3 (285 patients) infections, with 44% and 72%, respectively, obtaining SVR. Other than genotype, the predictors of SVR were age ≤ 45 years at the start of treatment, completion of unmodified treatment, the absence of cirrhosis and non-European origin.ConclusionsThe effectiveness of peginterferon and ribavirin treatment for chronic hepatitis C in a routine clinical practice is comparable to that observed in controlled clinical trials, with a higher SVR rate in genotype 2 and 3 patients compared to genotype 1 patients. Our data further indicate that age at start of treatment is a strong predictor of SVR irrespective of HCV genotype, with patients 45 years or younger having a higher SVR rate.

Clinical Profile and Response to Treatment with Pegylated Interferon α 2b and Ribavirin in Chronic Hepatitis C—A Reappraisal from a Tertiary Care Center in Northern India

“…[11][12][13][14][15] In contrast, most of the studies from USA, Europe and Japan have reported a prevalence rate of 60%-70% of genotype 1b and 1a in patients with CH-C. 16 HCV treatment responses vary with the genotype, with the highest SVR rates observed for genotype 2, 3 (72-80%) and the lowest rates observed for genotypes 1 and 4 (44-50%). 13,[17][18][19] Our study population also showed similar results as genotype 1 (20%) had significantly low SVR as compared to genotype 3/2 (92.0%).…”

Efficacy of Treatment With Pegylated Interferon and Ribavirin in Patients With Chronic HCV Infection “Under Real Life“ Conditions

“…Some investigators found female gender as the positive predictor for SVR in RCT and in "real life condition"studies [9,24,25,56,63,64]. The others did not confirm these results [20,40,42,44,65], or even found that response to combined treatment and SVR in females 50 years old or older was poorer than in males [66]. Low estrogens level in older women could be responsible for their impaired response to antiviral treatment.…”

“…Patients infected with "easy-to-treat" genotypes 2 and 3 respond much better than those with "difficult-to-treat" genotypes 1 and 4. HCV genotype, pretreatment viral load, ethnicity, gender, presence of cirrhosis or advanced fibrosis, obesity, steatosis, insulin resistance, elevated γGT and other are significantly associated with the outcome of Peg-IFN plus RBV combination therapy [32,[34][35][36][37][38]. Furthermore, those with low pretreatment viral load respond much better than those with high pretreatment viral load.…”

“…Some studies showed SVR similar to that obtained during RCT. Danish nationwide cohort study [38], presented the data obtained in a routine clinical practice and found them comparable to those observed in controlled clinical trials: overall 57.9 % of patients achieved SVR: it was 46.5 % in patients with genotype 1/4 infection and 77.3 % in those with genotype 2/3 infection. Some other authors [39][40][41][42][43][44][45] and community based studies in Germany, Canada, France and Australia [46][47][48][49][50][51] reported SVR data comparable with those in RCT too.…”

Hepatitt C-behandling ved tre norske sykehus 2000 – 11

“…Genotype 7 ble nylig påvist i Afrika og er ikke testet for i den aktuelle perioden (1). Vi har begrensede data fra Skandinavia om effekten av hepatitt C-virusbehandling administrert i vanlig klinisk praksis (9,10).…”