Peginterferon alfa-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®) in retreatment of chronic hepatitis C patients, nonresponders and relapsers to previous conventional interferon plus ribavirin therapy

Parise, Eduardo R; Cheinquer, Hugo; Crespo, D; Meirelles, A.; Martinelli, Ana de Lôurdes Candolo; Sette, H; Gallizi, J.; Silva, R.; Lacet, Celina Maria Costa; Corrêa, Elisa Cristina Delfini; Cotrim, Helma Pinchemel; Fonseca, José Carlos Ferraz da; Paraná, Raymundo; Spinelli, V.; Amorim, Welma Wildes; Tatsch, Fernando; Pessôa, Mário

doi:10.1590/s1413-86702006000100003

Cited by 27 publications

(28 citation statements)

References 12 publications

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“…Of those, only 17% of the individuals infected with genotype 1, in comparison with 57% of the individuals infected with genotypes 2 or 3, achieved an SVR. Therefore, genotype had an influence on SVR in the previous nonresponders who underwent retreatment.Studies conducted in Brazil and involving nonresponders to IFN/RBV demonstrated SVR rates resulting from retreatment with the PEG-IFN alpha-2a + RBV regimen [10], as well as with the PEG-IFN alpha-2b + RBV regimen [11], that were higher than those reported in international studies. Of the relapsers treated, 57% [10] and 62% [11] achieved an SVR.…”

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confidence: 68%

“…Studies conducted in Brazil and involving nonresponders to IFN/RBV demonstrated SVR rates resulting from retreatment with the PEG-IFN alpha-2a + RBV regimen [10], as well as with the PEG-IFN alpha-2b + RBV regimen [11], that were higher than those reported in international studies. Of the relapsers treated, 57% [10] and 62% [11] achieved an SVR.…”

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“…These SVR rates in relapsers are higher than, for example, the rates of 41% and 59% obtained, respectively, in Canada (by Sherman et al) and in France (by Moucari et al) [12,13]. In analyzing the response in relapsers by genotype, the Brazilian researchers found that an SVR was achieved in 69-70% of those infected with genotype 3, compared with 43-44% of those infected with genotype 1 [10,11].True nonresponders, that is, patients who never presented viral negativity during or at the end of the treatment, are the most difficult group to retreat. Some authors showed that, after previous treatment with conventional IFN, with or without RBV, relapsers have significantly higher SVR when retreated with PEG-IFN alpha-2b and RBV than do nonresponders to previous treatment (55% vs. 20%; p<0.001) [9].…”

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confidence: 82%

“…Of the relapsers treated, 57% [10] and 62% [11] achieved an SVR. These SVR rates in relapsers are higher than, for example, the rates of 41% and 59% obtained, respectively, in Canada (by Sherman et al) and in France (by Moucari et al) [12,13].…”

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confidence: 98%

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Retreatment of hepatitis C patients who previously experienced treatment failure

Gonçales

Lopes²

2007

Braz J Infect Dis

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In its different formulations, interferon (IFN) alpha combined with ribavirin (RBV) is the best treatment alternative for patients infected with the hepatitis C virus (HCV) [1]. In such patients, the objective is to achieve an end-of-treatment virological response -negative serum HCV ribonucleic acid (RNA) -followed by a sustained virological response (SVR), which is defined as HCV RNA negativity for six months after the suspension of treatment.The treatment regimens for HCV infection have evolved from monotherapy with conventional IFN alpha to combined therapy with IFN and RBV and, more recently, to combined therapy with pegylated IFN (PEG-IFN alpha-2a or alpha-2b) and RBV [2,3]. It is known that approximately 60% of the patients infected with HCV genotype 1 and nearly 40% of those infected with genotype 3 do not achieve an SVR when treated with the conventional regimen of . The availability of PEG-IFNs has reduced the percentage of patients experiencing treatment failure. In large international trials involving treatment-naïve patients, regimens that include the combination of PEG-IFN and RBV have produced significantly higher rates of SVR than those observed with the use of the conventional combination of IFN and RBV (54-56% vs. 44-47%) [5][6][7].Similar to what occurs in treatment-naïve patients, retreatment provides the patient with a new chance to achieve an SVR. Long-term studies have proven that the vast majority of the patients who achieve an SVR usually remain negative for HCV RNA for a long time [8].The arguments in favor of retreating patients would be the possibility of eradicating HCV, reducing fibrosis, and decreasing the risk of evolving to hepatocarcinoma. With regard to the new antiviral agents, we do not know when they will be available or whether all patients will be able to wait several years to initiate retreatment.It is known that patients who experience relapse after treatment with conventional IFN, with or without RBV, respond better to retreatment with PEG-IFN alpha and RBV than do those presenting no response to treatment with conventional IFN (with or without RBV). Krawitt et al. observed an SVR rate of 55% in 66 relapsing patients who were retreated with PEG-IFN alpha-2b (100-150 µg/week) and RBV (1000 mg/day), compared with only 20% in 116 previous nonresponders treated with the same regimen [9]. An SVR was observed in 53% of the relapsing patients infected with genotype 1, compared with 59% of the relapsing patients infected with genotypes 2 or 3. There were, therefore, no significant differences between these groups of patients. This was not observed in the previous nonresponders receiving retreatment. Of those, only 17% of the individuals infected with genotype 1, in comparison with 57% of the individuals infected with genotypes 2 or 3, achieved an SVR. Therefore, genotype had an influence on SVR in the previous nonresponders who underwent retreatment.Studies conducted in Brazil and involving nonresponders to IFN/RBV demonstrated SVR rates resulting from retreatment with the PEG-...

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