Risk factors for relapse in chronic hepatitis C patients who have achieved end of treatment response

LecT-Hepa facilitates estimating treatment outcome during interferon therapy in chronic hepatitis C patients

Background

A combination treatment of interferon and ribavirin is the standard and the commonly used treatment for chronic hepatitis C (CHC). Developing noninvasive tests like serum indicators that can predict treatment outcome at an early stage of therapy is beneficial for individualized treatment and management of CHC. A glyco-indicator based on the glyco-alteration of serum α1-acid glycoprotein, LecT-Hepa, was discovered by glycomics technologies as a robust indicator of liver fibrosis. Here, we investigated the clinical utility of LecT-Hepa for evaluation of treatment outcome.

Results

Firstly, ninety-seven patients with CHC were used for comparison of LecT-Hepa in serum and plasma. We found no significant difference in the concentrations of LecT-Hepa in serum and plasma. And then, 213 serum specimens from 45 patients who received 48 weeks of treatment with interferon and ribavirin were followed up for 96 weeks, and were used for evaluation of the role of LecT-Hepa. We found that LecT-Hepa might reflect the change in fibrosis regression during the treatment process. Moreover, the change of LecT-Hepa at the first 12 weeks of treatment could already predict the antiviral treatment response, which was more superior to FIB-4 index and aspartate aminotransferase-to-platelet ratio index (APRI) in this study.

Conclusions

These results provide a new perspective that serum glycoprotein could be used as a joint diagnosis indicator for estimation treatment outcome of viral hepatitis at earlier stage of therapy.

Electronic supplementary material

The online version of this article (doi:10.1186/1559-0275-11-44) contains supplementary material, which is available to authorized users.

A retrospective study of peginterferon plus ribavirin for treatment of chronic hepatitis C in patients who had undergone previous antiviral therapy

AIM: To evaluate the virologic responses and safety of peginterferon plus ribavirin therapy for treatment of chronic hepatitis C (CHC) in patients who had undergone previous antiviral therapy.

METHODS: All patients were divided into two groups based on the type of previously used interferon. Virologic responses, including rapid virologic response (RVR), early virologic response (EVR), end-of-treatment virologic response (ETR) and sustained virologic response (SVR), relapse rate and discontinuation rate were assessed after retreatment with peginterferon plus ribavirin.

RESULTS: For CHC patients previously treated with peginterferon plus ribavirin, retreatment by the same regimen might be associated with lower RVR, EVR, ETR and SVR rates (21.1% vs 40.5%, 26.3% vs 43.2%, 47.4% vs 56.8%, 31.6% vs 46.0%) and a higher relapse rate (33.3% vs 19.0%), but no significance was found compared with those treated with standard interferon (all P > 0.05). Achieving EVR might be a positive factor for achieving SVR in patients previously treated with interferons (IFNs) (OR = 20.43, P = 0.004).

CONCLUSION: Peginterferon plus ribavirin therapy is effective for CHC patients previously treated with IFNs; however, retreatment with the same regimen for CHC patients previously treated with peginterferon plus ribavirin is not recommended. Achieving EVR might be a positive factor for achieving SVR in patients previously treated with IFNs.

Analysis of variables and interactions among variables associated with a sustained virological response to pegylated interferon alfa-2a plus ribavirin in hepatitis C virus genotype 3-infected patients

BACKGROUND

The recommended standard therapeutic regimen for chronic hepatitis patients with hepatitis C virus (HCV) genotype 3 is pegylated interferon plus ribavirin for 24 weeks. The aim of the present study was to evaluate treatment efficacy and variables predictive of treatment success, interactions among variables contributing to a response to therapy, and the utility of the rapid virological response (RVR; week 4 virological response) to predict treatment outcomes in HCV genotype 3-infected patients in routine clinical practice.

METHODS

We prospectively studied baseline and during-treatment factors associated with a sustained virological response (SVR) in HCV genotype 3-infected patients who received pegylated interferon alfa-2a (PEG-IFN α2a) 180 μg/week plus ribavirin 800 mg daily for 24 weeks and who were followed for 24 weeks after the completion of treatment.

RESULTS

Four hundred and twenty-six treated patients were included in the analysis; 320 (75.1%) showed an SVR. The following factors were assessed for their ability to predict SVR by means of univariable and multivariable logistic regression analysis: patient age, sex, pre-treatment viral load, pre-treatment alanine aminotransferase (ALT), body mass index (BMI), and RVR. Four factors - age, pre-treatment viral load, pre-treatment ALT, and RVR - were statistically significant predictors of SVR (p<0.05) in the univariable analysis. Factors showing a significant association with SVR were assessed by multivariable logistic regression analysis. In the multivariable analysis, independent factors associated with SVR were the attainment of RVR (odds ratio (OR) 11, 95% confidence interval (CI) 6.15-20.69; p<0.0001), patient age ≤40 years (OR 4.2, 95% CI 2.30-7.96, p<0.0001), and a low pre-treatment viral load (≤8 × 10(5) IU/ml; OR 3.4, 95% CI 1.87-6.25; p<0.0001). The effect of RVR in patients aged >40 years was more pronounced than in those aged ≤40 years: 81.1% of patients aged >40 years who achieved an RVR had an SVR, whereas only 7.5% of patients aged >40 years who did not achieve an RVR had an SVR (p<0.05).

CONCLUSIONS

RVR is an independent variable that is predictive of SVR. Moreover older patients (>40 years) who achieve an RVR are likely to have an SVR, while patients who do not achieve an RVR and who have a high pre-treatment viral load (>8 × 10(5) IU/ml) are unlikely to have an SVR.

Association of a single nucleotide polymorphism near the interleukin-28B gene with response to hepatitis C therapy in Asian patients

BACKGROUND AND AIMS

A single nucleotide polymorphism near the interleukin-28B (IL28B) gene has been shown to predict hepatitis C virus (HCV) treatment response. We aim to determine the role of the IL28B genotype in Asian patients.

METHODS

A total of 118 patients (all Korean, 55 patients with genotype 1 infection and 63 patients with genotype 2 infection) were consecutively enrolled and analyzed.

RESULTS

The sustained virological response (SVR) rate was 74% (87/118), while 26 patients (22%) relapsed and five patients were non-responders (4%). For rs8099917, the frequencies of major homozygotes (TT), heterozygotes (GT), and minor homozygotes (GG) were 0.85, 0.14 and 0.01, respectively. Of the 55 patients with HCV genotype 1 infection, the SVR rate was 67% and 44% (P = 0.19) and the non-response rate was 2% and 22% (P = 0.015) for the major allele and minor or hetero allele, respectively. Of the 63 patients with HCV genotype 2 infection, the SVR rate was 80% and 100% (P = 0.13) and the non-response rate was 4% and 0% (P = 0.55) for major allele and hetero allele, respectively.

CONCLUSIONS

The IL28B genotype may help identify non-responding patients in HCV genotype 1, but not in HCV genotype 2. Because of the high frequency of favorable alleles and the low frequency of non-response, the IL28B polymorphism may play a smaller role in Asian patients.

Effects of host and virus related factors on interferon-α+ribavirin and pegylated-interferon+ribavirin treatment outcomes in chronic Hepatitis C patients

Background

Current standard therapy commonly followed for chronic Hepatitis C Virus (HCV) in Pakistan is interferon alpha plus ribavirin combination therapy (IFN α/ribavirin) and pegylated interferon plus ribavirin (PegIFN/ribavirin). PegIFN/ribavirin has increased rate of sustained virological response than standard IFN α/ribavirin therapy. Objective of current study was to analyze rate of early and delayed response to antiviral treatment as well as rate of relapse response in patients following standard treatment IFN α/ribavirin and in patients following pegylated interferon treatment.

Methods

Baseline serum samples of 153 patients enrolled for IFN α/ribavirin and 50 patients for PegIFN/ribavirin were collected. After total RNA extraction, genotyping was and HCV RNA viral load was done. Subsequently HCV RNA viral load was estimated at 4 weeks of treatment, at 12 weeks, at 24 or 48 weeks and finally after 6 months follow up period. All the data was statistically analyzed using fisher's exact test.

Results

Total 86 patients out of 153 patients following conventional IFN α/ribavirin therapy completed treatment and 69% of them showed Rapid Virological Response (RVR). Whereas 50 patients following PegIFN/ribavirin treatment completed treatment and 80% of them achieved RVR. Total 64 out of 86 patients following IFN α/ribavirin therapy completed follow up period and 53.5% of them achieved Sustainded Virologcal Response (SVR). Forty-five out of total 50 patients who received PegIFN/ribavirin treatment completed 6 months follow up period and among these 70% achieved SVR. SVR rates were significantly associated with RVR (p < 0.001), age (p < 0.001) and gender (p < 0.01)

Conclusions

Rate of sustained virological response can be determined by factors like rapid virological response and age since they share significant association with one another. More over rate of SVR was more prominent in males than in females.

Efficacy of peg-interferon-α-2a plus ribavirin for patients aged 60 years and older with chronic hepatitis C in Korea

BACKGROUND AND AIM

In the present study, we evaluated the safety and efficacy of combination therapy with pegylated interferon and ribavirin for treating chronic hepatitis C (CHC) patients aged 60 years and older.

METHODS

A total of 314 CHC patients, who were treated with combination therapy, were classified into three groups according to age: (i) younger than 50 years (n = 137); (ii) 50-59 years (n = 109); and (iii) 60 years or older (n = 68). The sustained virological response (SVR) and discontinuation rates were compared between the three groups.

RESULTS

Discontinuation of therapy due to adverse event was more frequent in the older patient groups: 1%, 5%, and 10% for the < 50-year, the 50-59-year, and the ≥ 60-year patient groups, respectively (P = 0.018). However, the older patient groups showed a SVR rate that was comparable to the SVR rates of the other age groups: 80%, 73%, and 75% for the < 50-year, 50-59-year, and ≥ 60-year- patient groups, respectively (P = 0.420). A multivariate analysis showed that the aspartate aminotransferase : platelet ratio index (APRI) was an independent predictor of an SVR. An SVR was achieved in 95% (19/20) of the elderly patients with an APRI < 0.80.

CONCLUSIONS

Although physicians must pay more attention to adverse events in the older patients, combination therapy can be considered for older patients, especially for patients with a low APRI.