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Wen SC, Cheng LC, Hsu JH, Lai HW, Shih PC, Tsai CC, Kuo WH. Assessment of baseline pretreatment factors and on-treatment virological response to predict sustained virological response in patients with chronic hepatitis C treated with pegylated interferon and ribavirin. ADVANCES IN DIGESTIVE MEDICINE 2017. [DOI: 10.1002/aid2.12004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Shi-Chi Wen
- Division of Gastroenterology; Department of Internal Medicine, Pao-Chien Hospital; Pingtung Taiwan
| | - Lung-Chih Cheng
- Division of Gastroenterology; Department of Internal Medicine, Pao-Chien Hospital; Pingtung Taiwan
| | - Jui-Hung Hsu
- Division of Gastroenterology; Department of Internal Medicine, Pao-Chien Hospital; Pingtung Taiwan
| | - Hsin-Wen Lai
- Division of Gastroenterology; Department of Internal Medicine, Pao-Chien Hospital; Pingtung Taiwan
| | - Pei-Chen Shih
- Department of Nursing; Pao-Chien Hospital; Pingtung Taiwan
| | - Chi-Chang Tsai
- Division of Gastroenterology; Department of Internal Medicine, Kaohsiung Armed Forces General Hospital; Kaohsiung Taiwan
| | - Wu-Hsien Kuo
- Division of Gastroenterology; Department of Internal Medicine, Kaohsiung Armed Forces General Hospital; Kaohsiung Taiwan
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Wu Q, Zhan FY, Chen EQ, Wang C, Li ZZ, Lei XZ. Predictors of Pegylated Interferon Alpha and Ribavirin Efficacy and Long-Term Assessment of Relapse in Patients With Chronic Hepatitis C: A One-Center Experience From China. HEPATITIS MONTHLY 2015; 15:e28836. [PMID: 26288635 PMCID: PMC4532945 DOI: 10.5812/hepatmon.15(6)2015.28836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/18/2015] [Accepted: 05/10/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sustained virological response (SVR) and virological relapse maintain pivotal roles in the management of chronic hepatitis C (CHC); however, there is little data regarding the long-term outcomes of patients with CHC in China. OBJECTIVES We aimed to investigate the predictive factors of therapeutic effect and viral relapse in patients who achieved end-of-treatment response (ETR). PATIENTS AND METHODS We retrospectively analyzed clinical, biochemical and virological data of 169 adult patients with CHC from China who were not treated with pegylated interferon-alpha (PEG IFN-α) and ribavirin, of which 142 achieved ETR and with a follow-up period ranging from six months to six years. Statistical analysis was performed by SPSS 20.0. RESULTS Of the 169 patients, 124 (73.4%) achieved SVR and 23 (16.2%) experienced relapses post-therapy in cases of ETR patients. We considered sex, age, alanine aminotransferase, aspartate transaminase, baseline hepatitis C virus RNA level, HCV genotypes, IL28B rs12979860 genotype, rapid virological response (RVR), and early virological response (EVR). For antiviral effect in patients with CHC, HCV genotypes (2, 3) (χ(2) = 11.285, P = 0.001), IL28B genotype (rs12979860 CC) (χ(2) = 16.552, P < 0.001), RVR (χ(2) = 37.339, P < 0.001), and EVR (χ(2) = 70.265, P < 0.001) were significantly correlated with achieving SVR. For ETR patients with long-term follow-up, the relapse rate within six months was significantly higher than within other periods during six-year follow-up (χ(2) = 7.792, P = 0.005). Relapse was virtually not observed after therapy ceased for 48 weeks. The IL28B genotype (rs12979860 CT/TT) (OR = 0.102; 95% CI, 0.031-0.339; P < 0.001), lower RVR (OR = 0.239; 95% CI, 0.078-0.738; P = 0.013), and EVR (OR = 0.102; 95% CI, 0.016-0.661; P = 0.017) were independent risk factors for relapse. CONCLUSIONS Our study comprehensively explored the predictive factors of therapeutic effect of administered drugs and analyzed viral relapse during a six-months to six-year follow-up period from China. The SVR may not be the perfect endpoint of HCV therapy in Chinese people; we recommend 48 weeks after treatment withdrawal as the suitable time point.
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Affiliation(s)
- Qin Wu
- Infectious Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Feng Yu Zhan
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - En Qiang Chen
- Infectious Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Cong Wang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Zhen Li
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Zhong Lei
- Infectious Diseases Center, West China Hospital, Sichuan University, Chengdu, China
- Corresponding Author: Xue Zhong Lei, Infectious Diseases Center, West China Hospital, Sichuan University, P. O. Box: 610041, Chengdu, China. Tel: +86-2885423346, Fax: +86-2885423052, E-mail:
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Federico A, Masarone M, Romano M, Dallio M, Rosato V, Persico M. Rapid Virological Response Represents the Highest Prediction Factor of Response to Antiviral Treatment in HCV-Related Chronic Hepatitis: a Multicenter Retrospective Study. HEPATITIS MONTHLY 2015; 15:e18640. [PMID: 26286149 PMCID: PMC4532787 DOI: 10.5812/hepatmon.15(6)2015.18640] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/26/2014] [Accepted: 06/22/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Standard [i.e. pegylated interferon (Peg-IFN) + ribavirin] treatment of hepatitis C virus (HCV)-related chronic hepatitis is associated with a sustained virological response (SVR) in 50 - 90% of patients. A rapid virological response (RVR) (i.e. negative HCV-RNA after 4 weeks of treatment) predicts SVR in almost 90% of patients. OBJECTIVES The main aim of this study was to assess the strength of RVR, as a predictive factor of antiviral treatment response. PATIENTS AND METHODS Using univariate and multivariate analysis, we retrospectively evaluated biochemical, metabolic, genetic and viral variables that might affect both RVR and SVR to Peg-IFN plus ribavirin, in 315 consecutive outpatients affected by HCV-related chronic hepatitis. RESULTS At univariate analysis, staging, body mass index, RVR, genotype and viral load were significantly related to SVR (P < 0.001). At multivariate analysis, RVR and genotype remained significant (P < 0.00001). The RVR had a predictive value of 83%. At univariate and multivariate analyses, diabetes (P = 0.003), genotype 2 (P = 0.000) and HCV-RNA values (P = 0.016) were independent predictors of RVR, even though at multivariate analyses, only genotype 2 was significantly related to RVR. When we stratified patients, according to genotype, no laboratory or clinical factors were predictive of RVR in genotype 1 patients at either univariate or multivariate analysis. In genotype 2 patients, staging (P = 0.029) and diabetes (P = 0.001) were the only significant predictors of RVR at univariate analyses, whereas no factor was independently related to RVR, at multivariate analysis. CONCLUSIONS The RVR is the strongest factor of SVR and infection with HCV genotype 2 is significantly associated with RVR. Neither biochemical and/or metabolic factors seem to exert influence on RVR.
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Affiliation(s)
- Alessandro Federico
- Department of Clinical and Experimental Medicine, Division of Hepatogastroenterology, Second University of Naples, Naples, Italy
- Corresponding Author: Alessandro Federico, Department of Clinical and Experimental Medicine, Division of Hepatogastroenterology, Second University of Naples, Naples, Italy. Tel: +39-0815666723, Fax: +39-0815666714, E-mail:
| | - Mario Masarone
- Department of Internal Medicine and Hepatology, Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
| | - Marco Romano
- Department of Clinical and Experimental Medicine, Division of Hepatogastroenterology, Second University of Naples, Naples, Italy
| | - Marcello Dallio
- Department of Clinical and Experimental Medicine, Division of Hepatogastroenterology, Second University of Naples, Naples, Italy
| | - Valerio Rosato
- IV Division of Internal Medicine and Hepatology, Second University of Naples, Naples, Italy
| | - Marcello Persico
- Department of Internal Medicine and Hepatology, Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
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Shimada N, Tsubota A, Atsukawa M, Abe H, Ide T, Takaguchi K, Chuganji Y, Toyoda H, Yoshizawa K, Ika M, Sato Y, Kato K, Kumada T, Sakamoto C, Aizawa Y, Sata M. A 48-week telaprevir-based triple combination therapy improves sustained virological response rate in previous non-responders to peginterferon and ribavirin with genotype 1b chronic hepatitis C: A multicenter study. Hepatol Res 2014; 44:E386-96. [PMID: 24606109 DOI: 10.1111/hepr.12323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/02/2014] [Accepted: 03/05/2014] [Indexed: 02/08/2023]
Abstract
AIM The sustained virological response (SVR) rate of non-responders to peginterferon and ribavirin therapy (PR) is low for 24-week telaprevir-based triple combination therapy (T12PR24), compared to that of treatment-naïve patients or previous-treatment relapsers. This study investigated which characteristics of non-responders were associated with a better SVR rate to 48-week therapy (T12PR48). METHODS A total of 103 Japanese non-responders with genotype 1b chronic hepatitis C received telaprevir-based therapy. Among them, 81 patients (50 partial and 31 null responders) received T12PR24 and 22 (seven partial and 15 null responders) who agreed to the extended therapy received T12PR48. RESULTS Multivariate logistic regression analysis for SVR identified the interleukin-28B (IL28B) rs8099917 TT genotype (P = 0.0005, odds ratio [OR] = 10.38), extended rapid virological response (P = 0.0008, OR = 7.02), T12PR48 regimen (P = 0.0016, OR = 9.31) and previous partial responders (P = 0.0022, OR = 5.89). Among partial responders, the SVR rate did not differ significantly between T12PR48 (85.7%) and T12PR24 (70.0%). Among null responders, the SVR rate was significantly higher with T12PR48 than T12PR24 (66.7% vs 22.6%, P = 0.0037). Among patients with the IL28B non-TT genotype, the SVR rate was significantly higher with T12PR48 than T12PR24 (68.8% vs 37.7%, P = 0.0288). Moreover, among null responders with the non-TT genotype, the SVR rate was significantly higher with T12PR48 than T12PR24 (66.7% vs 9.1%, P = 0.0009). CONCLUSION T12PR48 improves the SVR rate in null responders, patients with the non-TT genotype, and null responders with a non-TT genotype.
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Affiliation(s)
- Noritomo Shimada
- Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, Matsudo, Japan
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Shimada N, Toyoda H, Tsubota A, Ide T, Takaguchi K, Kato K, Kondoh M, Matsuyama K, Kumada T, Sata M. Baseline factors and very early viral response (week 1) for predicting sustained virological response in telaprevir-based triple combination therapy for Japanese genotype 1b chronic hepatitis C patients: a multicenter study. J Gastroenterol 2014; 49:1485-94. [PMID: 24287582 DOI: 10.1007/s00535-013-0918-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 11/11/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Genetic polymorphisms near Interleukin 28B (IL28B) (rs8099917) and a rapid virological response (RVR) have been reported as predictors for a sustained virological response (SVR) to telaprevir (TVR)-based triple combination therapy. However, the association between SVR and viral kinetics earlier than week 4 after initiation of therapy remains unclear. Thus, we evaluated the SVR prediction ability of baseline factors and reduced hepatitis C virus (HCV) RNA levels at week 1 after the initiation of TVR-based therapy in Japanese genotype-1b chronic hepatitis C (CHC) patients. METHODS A total of 156 Japanese CHC patients received a 24-week regimen of TVR-based therapy. Baseline factors and reduction in HCV RNA levels at weeks 1 and 4 after the initiation of therapy were analyzed for SVR prediction. RESULTS Multiple logistic regression analysis for SVR in TVR-based therapy identified the IL28B TT genotype, a reduction of ≥ 4.7 log10 IU/mL in HCV RNA levels at week 1, RVR, and treatment-naïve/relapse. Whereas the SVR rate was higher than 90 % regardless of the reduction in HCV RNA levels at week 1 in patients with the TT genotype, a reduction of ≥ 4.7 log10 IU/mL in HCV RNA levels at week 1 was the strongest predictor of SVR in patients with the non-TT genotype, as determined by multiple logistic regression analysis (P = 0.0043). CONCLUSIONS The IL28B TT genotype is the most important baseline factor for predicting SVR, and a ≥ 4.7 log10 IU/mL reduction in HCV RNA at week 1 is a useful very early on-treatment predictor of SVR, especially in the non-TT genotype.
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Affiliation(s)
- Noritomo Shimada
- Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, 1-380 Shinmatsudo, Matsudo, Chiba, 270-0034, Japan,
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Toyoda H, Kumada T, Shimada N, Takaguchi K, Ide T, Sata M, Ginba H, Matsuyama K, Izumi N. Characteristics and Outcomes of HCV Genotype-1-Infected Patients Treated with Peginterferon and Ribavirin Combination Therapy with Discordant HCV Responses 4 and 12 Weeks after Starting Therapy. Intervirology 2014; 57:289-96. [DOI: 10.1159/000362721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 04/08/2014] [Indexed: 11/19/2022] Open
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Shimada N, Tsubota A, Atsukawa M, Abe H, Ika M, Kato K, Sato Y, Kondo C, Sakamoto C, Tanaka Y, Aizawa Y. α-Fetoprotein is a surrogate marker for predicting treatment failure in telaprevir-based triple combination therapy for genotype 1b chronic hepatitis C Japanese patients with the IL28B minor genotype. J Med Virol 2014; 86:461-72. [PMID: 24166425 DOI: 10.1002/jmv.23824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 12/14/2022]
Abstract
Even when treated with telaprevir-based triple therapy, some patients fail to achieve a sustained virological response. This study identified factors related closely to treatment failure. A total of 146 Japanese genotype 1b chronic hepatitis C patients were enrolled in this prospective, multicenter study and received a 24-week regimen of triple therapy. The end-of-treatment response rate was significantly lower in patients with the interleukin 28B (IL28B) (rs8099917) non-TT genotype (85.2%) than in those with the TT genotype (100%, P = 0.0002). Multiple logistic regression analysis identified high α-fetoprotein levels as an independent factor related to non-end-of-treatment response in patients with the non-TT genotype. A cut-off value of 20 ng/ml was determined for a non-end-of-treatment response; sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 75.0%, 95.7%, 75.0%, 75.0%, and 92.6%, respectively. Multiple logistic regression analysis for a sustained virological response identified the IL28B TT genotype, low α-fetoprotein levels, non-responders, and a rapid virological response. The sustained virological response rate was significantly lower in patients with the non-TT genotype (59.3%) than in those with the TT genotype (96.7%, P < 0.0001). In patients with the non-TT genotype, α-fetoprotein was the most significant predictor for non-sustained virological response by univariate analysis. A cut-off value of 7.4 ng/ml α-fetoprotein was determined for non-sustained virological response; sensitivity, specificity, PPV, NPV, and accuracy were 63.6%, 87.5%, 77.8%, 77.8%, and 77.8%, respectively. For the non-TT patients, serum α-fetoprotein levels may be a surrogate marker for predicting treatment failure in telaprevir-based therapy for genotype 1b chronic hepatitis C.
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Affiliation(s)
- Noritomo Shimada
- Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, Matsudo, Chiba, Japan
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