From the literature on the hepatitis C virus, the existence of a gap between a sustained virologic response attainable in randomized clinical trials versus routine practice is not clear.
Further, in terms of the pretreatment prediction of sustained virological response, to date, studies have focused only on reporting the magnitude of association between each predictor and an sustained virologic response.
They fail to acknowledge that a predictor with a large magnitude of association is of little value to clinicians if it has low variability in the treatment population.
Dr Hamish Innes and colleagues used hepatitis C virus clinical databases to derive a large, representative cohort of Scottish pegylated interferon and ribavirin initiates.
Overall, 39% of genotype 1 and 70% of genotype 2/3 patients achieved a sustained virological response.
70% of genotype 2/3 patients achieved a sustained virological response
European Journal Gastroenterology & Hepatology
This compares with the pooled estimates of 47% for genotype 1, and 80% for genotype 2/3 randomized clinical trials participants.
Significant predictors of sustained virological response identified from logistic regression were ranked on the basis of the akaike information criteria.
The researchers found that significant predictors included genotype, % increase in akaike information criteria of the final model when variables are excluded, γ-glutamyl transferase, platelet count, alanine aminotransferase quotient, ever infected with hepatitis B virus, and sex.
Dr Innes' team concludes, "The proportion of patients attaining an sustained virologic response in Scottish routine practice is marginally lower than in randomized clinical trials, and other than genotype, γ-glutamyl transferase emerges as a valuable predictor of an sustained virologic response in routine practice."
"Further, we demonstrate an approach to more clearly discern the predictive value of response predictors."
| Eur J Gastroenterol Hepatol 2012: 24(6): 646–655 24 May 2012 |
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