Real world experience with pegylated interferon and ribavirin in hepatitis C genotype 1 population with favourableIL28Bpolymorphism

Abstract

Background and aim: Conventional hepatitis C treatment using pegylated interferon (PEG-IFN) and ribavirin is associated with significant side effects. IL28B polymorphism can predict response to treatment, with CC genotype having a better response. ITPA gene deficiency protects against clinically significant anaemia induced by treatment. The purpose of this study was to determine IL28B polymorphism and ITPA variation among hepatitis C genotype 1 patients who have undergone therapy with PEG-IFN and ribavirin and their association with sustained viral response (SVR). Methods: All hepatitis C genotype 1 patients who had been treated with PEG-IFN and ribavirin over the past 10 years were identified by available medical records and were contacted by letter of invitation to participate in the study. Blood samples for IL28B and ITPA genotyping were obtained. Medical records were reviewed for verification of treatment response, development of anaemia and if treatment reduction was required during the treatment. Results: A total of 61 patients with hepatitis C genotype 1 were treated with PEG-IFN and ribavirin, of whom 42 agreed to participate in the study. Mean age was 45.6±12.9 years at time of treatment, and 83.3% of patients were males. Thirty-three (78.6%) had IL28B CC genotype, of whom 25 (75.8%) obtained SVR compared with only 3 of 9 (33.3%) non C/C genotype patients who achieved SVR (P=0.041). Eleven (26.1%) patients had ITPA AC genotype, and 30 (71.4%) had CC genotype. There was no statistically significant difference between ITPA AC and CC genotypes in predicting clinically significant anaemia (45.5% vs 63.3%, P=0.302). Even among patients who developed anaemia, 70.8% still managed to achieve SVR. Treatment reduction also had no impact on SVR. Conclusion: Hepatitis C genotype 1 patients should be informed of the response rate for treatment with PEG-IFN and ribavirin in a population with favourable IL28B genotype before consideration of newer therapeutic options.

Prevalence of hepatitis C virus infection and the IL28B genotype polymorphism among blood donors and high-risk populations

“…Our results showed that there was a predominance (85.3% overall) of the favourable CC allele in these populations. Given our findings and the prohibitive cost of DAA agents, and keeping in mind that IL28B SNP is highly associated with increased sustained viral response following conventional PEG-IFN+RBV combination therapy for CHC, (8,(21)(22)(23)(24) it would seem reasonable to consider IL28B genotyping a priority, with the view of using PEG-IFN+RBV combination therapy as a first-line treatment for CHC, when appropriate, for a substantial proportion of the HCV-infected population in Singapore. Thus, the costly DAA agents can be reserved for the minority who have contraindications to, or poor predictive factors for sustained viral response following PEG-IFN+RBV combination therapy.…”

A Tetra-Primer Amplification Refractory Mutation System–Polymerase Chain Reaction (T-ARMS-PCR) for Genotyping of rs8099917 & rs12979860 IL28B Polymorphisms and Its Correlation of Various Variables in Iranian HCV Patients

“…This has raised a global discussion among competing health priorities, regarding the unrestricted access of all patients to new therapies. It has been suggested to consider IFN-based regimens as valuable treatment of HCV patients with favorable genotypes of IL28B, who are still unable to afford the newer DAAs, especially in resource-limited Asian countries where favorable genotypes of IL 28B is highly prevalent [18].…”

Authors’ reply: Comment on: Prevalence of hepatitis C virus infection and the IL28B genotype polymorphism among blood donors and high-risk populations

“…The use of IL2BB polymorphism is mentioned as a "viable treatment option", and this has been studied in our group previously. (6) Yours sincerely,…”