Hepatitis C: Peginterferon/ribavirin achieves long-term suppression

Peginterferon/ribavirin achieves long-term HCV suppression

Last Updated: 2010-12-07 17:45:11 -0400 (Reuters Health)

By C. Vidya Shankar, MD

NEW YORK (Reuters Health) - Pegylated interferon alfa-2a alone or in combination with ribavirin maintains sustained virologic response (SVR) for long durations and can achieve a virological cure in hepatitis C (HCV) infection, a new multi-center study shows.

The SVR -- defined as HCV RNA below 50 IU/mL 24 weeks after completion of treatment -- was maintained in 99% of patients during the four-year follow up period, researchers report in the November issue of Gastroenterology.

"The clinical implications are significant clinically and emotionally for patients, in that patients who are found to be HCV RNA negative 6 months after finishing therapy for HCV can be told that they are essentially cured from their disease," Dr. Mark G. Swain, the lead author and Professor of Medicine at the University of Calgary, Canada, told Reuters Health.

Though peginterferon and ribavirin combination is the standard treatment, "limited data exist regarding the long-term durability of an SVR following peginterferon treatment for chronic hepatitis C," the researchers point out.

Dr. Swain and his team examined the long term outcomes of 1343 hepatitis C patients who had completed treatment from prospective randomized trials in nine locations worldwide.

Overall, 1077 patients had received peginterferon alfa-2a in combination with ribavirin, 166 received only peginterferon alfa-2a, while 100 were also HIV positive and had received either interferon or interferon/ribavirin. Subcutaneous peginterferon doses ranged from 90 - 270 mcg/week, and ribavirin from 800-1600 mg/day, both given for up to 48 weeks.

The study population was HCV negative on completion of treatment, and they were followed up annually with assessment of viral load by PCR and liver function.

After a mean follow-up of 3.9 years, 1331 patients (99.1%) were HCV RNA negative and thus maintained the SVR, the researchers report. The SVR was similar in peginterferon/ribavirin combination (99.2%), peginterferon (98.8%) and HIV co-infection (99%) groups.

"These data suggest that the recurrence of HCV RNA is extremely rare in patients who achieve an SVR, and it now appears likely that such patients may be considered cured from a virologic standpoint," the authors say.

Rather than repeated testing, "we recommend one follow-up HCV PCR at 1 year post-treatment, and when negative we discharge these patients from our clinic," Dr. Swain said.

"Being told that they are cured has a very significant emotional impact on these patients with regards to their quality of life," he concluded.

SOURCE: http://link.reuters.com/qyf98q

Gastroenterology 2010;139:1593-1601.