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Marotta P, Bailey R, Elkashab M, Farley J, Feinman SV, Peltekian K, Poliquin M, Witt-Sullivan H, Rampakakis E, Drolet M, Cooper C. Real-world effectiveness of peginterferon α-2b plus ribavirin in a Canadian cohort of treatment-naïve chronic hepatitis C patients with genotypes 2 or 3: results of the PoWer and RediPEN studies. Eur J Clin Microbiol Infect Dis 2016; 35:597-609. [PMID: 26851949 PMCID: PMC4819461 DOI: 10.1007/s10096-016-2576-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/04/2016] [Indexed: 01/02/2023]
Abstract
The purpose of this investigation was to assess the real-life effectiveness of pegylated interferon (peg-IFN) α-2b with ribavirin (RBV) in a cohort of treatment-naïve patients with chronic genotypes 2 (G2) or 3 (G3) hepatitis C virus (HCV) infection. A post-hoc pooled analysis of two Canadian multicenter, observational studies, RediPEN and PoWer, was carried out. A total of 1242 G2- or G3-infected patients were included. The primary outcome was sustained virologic response (SVR). Secondary endpoints included early virologic response (EVR), end-of-treatment (EOT) response, and relapse. Multivariate logistic regression was used to identify independent predictors of treatment response. SVR in G2 and G3 was 74.4 % and 63.6 %, respectively. Relapse occurred in 12.7 % and 19.1 % of G2- and G3-infected patients achieving EOT response, respectively. Overall, G3 was found to independently predict reduced SVR [odds ratio (OR) = 0.20; p = 0.007] and increased relapse (OR = 6.84; p = 0.022). Among G3-infected patients, increasing fibrosis score was the most important factor predicting reduced SVR [F2 vs. F0/F1 (OR = 0.41; p = 0.009); F3 vs. F0/F1 (OR = 0.72; p = 0.338); F4 vs. F0/F1 (OR = 0.27; p = 0.001)]. Male gender (OR = 13.16; p = 0.020) and higher fibrosis score [F2 vs. F0/F1 (OR = 9.72; p = 0.016); F3/F4 vs. F0/F1 (OR = 4.23; p = 0.113)] were associated with increased relapse in G3 patients. These results support the real-life effectiveness of peg-IFN α-2b plus ribavirin in HCV G2- and G3-infected patients. Overall, genotype was identified as the most significant predictor of treatment outcome. Fibrosis score and gender were key outcome predictors in the G3-infected population. In clinical settings, peg-INF/RBV offers an alternative for patients without access to all oral direct-acting antivirals.
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Affiliation(s)
- P Marotta
- London Health Sciences Center, London, ON, Canada
| | - R Bailey
- University of Alberta, Edmonton, AB, Canada
| | - M Elkashab
- Toronto Liver Centre, Toronto, ON, Canada
| | - J Farley
- Dr. John Farley Inc., Vancouver, BC, Canada
| | | | - K Peltekian
- Atlantic Hepatology Services, Halifax, NS, Canada
| | - M Poliquin
- Clinique Médicale L'Actuel, Montreal, QC, Canada
| | | | - E Rampakakis
- JSS Medical Research Inc., St-Laurent, QC, Canada.
| | - M Drolet
- Merck Canada Inc., Kirkland, QC, Canada
| | - C Cooper
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Aghemo A, Rumi MG, Monico S, Prati GM, D'Ambrosio R, Donato MF, Colombo M. The pattern of pegylated interferon-α2b and ribavirin treatment failure in cirrhotic patients depends on hepatitis C virus genotype. Antivir Ther 2009. [DOI: 10.1177/135965350901400415] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Failure of anti-hepatitis C therapy encompasses both primary non-response and post-treatment relapse. Treatment failure to pegylated interferon (PEG-IFN)-α2b and ribavirin (RBV) largely depends upon virus genotype, but the interaction between genotype, cirrhosis and pattern of treatment failure is unclear. We aimed to assess whether cirrhosis modifies the pattern of PEG-IFN-α2b and RBV treatment failure. Methods A total of 471 treatment-naive patients with histologically proven chronic hepatitis C virus (HCV) infection (106 with cirrhosis; 185 with HCV genotype 1 [HCV-1], 157 with HCV genotype 2 [HCV-2], 92 with HCV genotype 3 [HCV-3] and 37 with HCV genotype 4 [HCV-4]) were consecutively treated with PEG-IFN-α2b 1.5 μg weekly and weight-based RBV. Results The sustained virological response (SVR) rates were 31% in HCV-1 and HCV-4, 80% in HCV-2 and 72% in HCV-3, and were lower in cirrhotic than in non-cirrhotic HCV-1 and HCV-4 (17% versus 36%; P=0.01), and HCV-3 (33% versus 79%; P=0.001), but not HCV-2 (69% versus 83%; P=0.1) patients. Treatment failure was the consequence of lower end-of-treatment response rates (37% versus 53%; P=0.06) plus higher post-treatment relapse rates (55% versus 31%; P=0.07) in cirrhotic HCV-1 and HCV-4 patients and higher rates of post-treatment relapse in HCV-2 (29% versus 10%; P=0.01) and HCV-3 cirrhotic patients (61% versus 12%; P<0.001). By multi-variate analysis, HCV-1 and HCV-4 (odds ratio [OR] 7.44, 95% confidence interval [CI] 4.87–11.36), and cirrhosis (OR 3.00, 95% CI 1.80–5.00) were independent predictors of treatment failure. Conclusions Cirrhosis is an important moderator of SVR, accounting for different patterns of treatment failure in patients infected with different genotypes.
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Affiliation(s)
- Alessio Aghemo
- AM Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Maria Grazia Rumi
- AM Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Sara Monico
- AM Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Gian Maria Prati
- AM Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Roberta D'Ambrosio
- AM Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Maria Francesca Donato
- AM Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Massimo Colombo
- AM Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
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Roff L, Colloredo G, Pioltelli P, Bellati G, Pozzi M, Parravicini P, Bellia V, Del Poggio P, Fornaciari G, Ceriani R, Ramella G, Corradi C, Rossini A, Bruno S. Pegylated Interferon-α2b plus Ribavirin: An Efficacious and well-Tolerated Treatment Regimen for Patients with Hepatitis C virus Related Histologically Proven Cirrhosis. Antivir Ther 2008. [DOI: 10.1177/135965350801300506] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Little is known about the efficacy, safety and tolerability of pegylated interferon plus ribavirin treatment in patients with chronic hepatitis C virus (HCV) infection and histologically proven fully established cirrhosis. We aimed here to evaluate the safety of this regimen in such patients and to identify baseline and on-treatment predictors of a sustained virological response (SVR). Methods Patients with histologically proven, HCV-induced cirrhosis were randomized to receive pegylated interferon-α2b (PEG-IFN-α2b; 1.0 μg/kg/week, n=56; group A) or recombinant interferon-α2b (IFN-α2b; 3 million IU three times/week, n=36; group B), each in combination with a weight-based dose of ribavirin (800–1,200 mg/day) for up to 48 weeks. The primary endpoint of the study was the assessment of SVR, defined as undetectable HCV RNA 24 weeks after treatment cessation. Results Overall, 40% (37/93) of patients attained SVR: 44% (25/57) in group A and 33% (12/36) in group B ( P=0.31). SVR rates were significantly higher in genotype 2/3 patients than in genotype 1 patients (69% versus 25%; P<0.0001). Platelet count at baseline, rapid virological response, and early virological response were predictors of SVR. Twelve patients discontinued treatment because of an adverse event and 20 patients required ribavirin dose reduction for the management of anaemia. Conclusions PEG-IFN-α2b plus ribavirin for 48 weeks is an efficacious and well-tolerated treatment regimen for patients with HCV-induced cirrhosis. Although SVR rates were more satisfactory in genotype 2/3 than in genotype 1 patients, our study identified additional predictors of response that could allow physicians to better manage treatment in this ‘difficult-to-cure’ subset of patients.
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Affiliation(s)
- Luigi Roff
- Department of Internal Medicine, Azienda Ospedaliera della Valtellina e della Valchiavenna, Sondrio, Italy
| | - Guido Colloredo
- Department of Internal Medicine, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Pietro Pioltelli
- Department of Internal Medicine, Azienda Ospedaliera San Gerardo, Università Milano-Bicocca, Monza, Italy
| | - Giorgio Bellati
- Department of Internal Medicine, Azienda Ospedaliera Santa Anna, Como, Italy
| | - Massimo Pozzi
- Department of Internal Medicine, Azienda Ospedaliera San Gerardo, Università Milano-Bicocca, Monza, Italy
| | - Pierpaolo Parravicini
- Department of Internal Medicine, Azienda Ospedaliera della Valtellina e della Valchiavenna, Sondrio, Italy
| | - Valentina Bellia
- Department of Internal Medicine, Azienda Ospedaliera della Valtellina e della Valchiavenna, Sondrio, Italy
| | - Paolo Del Poggio
- Department of Internal Medicine, Azienda Ospedaliera Treviglio, Italy
| | - Giovanni Fornaciari
- Department of Internal Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Roberto Ceriani
- Department of Internal Medicine, Istituto Clinico Humanitas, Milan, Italy
| | - Giuliano Ramella
- Department of Internal Medicine, Azienda Ospedaliera di Melegnano, Italy
| | - Chiara Corradi
- Department of Internal Medicine, Azienda Ospedaliera Santa Anna, Como, Italy
| | - Angelo Rossini
- Department of Internal Medicine, Ospedale Civile, Brescia, Italy
| | - Savino Bruno
- Internal Medicine and Liver Unit, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
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