Predictors of early treatment discontinuation in Hepatitis C Genotype 1

Predictors of early treatment discontinuation in Hepatitis C
This month's Clinical Gastroenterology and Hepatology identifies predictors of early treatment discontinuation among patients with genotype 1 Hepatitis C.

A significant proportion of patients with hepatitis C virus infection discontinue antiviral treatment prematurely.

Risk factors for discontinuation before 48 weeks among patients with genotype 1 hepatitis C virus vary over the course of therapy.

Dr Lauren Beste and colleagues from Washington, USA investigated the rates and risk factors for treatment discontinuation within 12 weeks, 12–24 weeks, and 24–48 weeks.

The researchers retrospectively evaluated data from all veterans affairs patients with genotype 1 hepatitis C virus who initiated pegylated interferon and ribavirin therapy from 2002–2007.

53% of patients completed at least 38 weeks of therapy
Clinical Gastroenterology and Hepatology
The team accounted for appropriate discontinuation because of viral nonresponse.

Overall, 53% of patients completed at least 38 weeks of therapy, 17% discontinued early in the setting of viral nonresponse, and 31% discontinued despite viral response or in the absence of virologic data.

Cirrhosis, diabetes, pretreatment substance use disorder, hemoglobin, and lack of hematopoietic growth factor use independently predicted discontinuation before 12 weeks.

Among patients with documented early virologic responses, higher baseline levels of creatinine, depression, and lack of growth factor use predicted discontinuation from 12–24 weeks.

The research team found that no factors independently predicted discontinuation from 24–48 weeks among patients responding to treatment at 24 weeks.

Dr Beste's team concluded, "Early discontinuation of antiviral therapy is common."

"Use of growth factors was the strongest independent predictor of treatment retention before 24 weeks and should be eveterans affairsluated prospectively."

"Early interventions may also be warranted for other risk factors for early discontinuation, such as pre-existing substance use, depression, cirrhosis, or diabetes."





Clin Gastrohep Hepatol 2010; 8(11):972-8
15 November 2010