Friday, August 17, 2012

Some patients with HCV may benefit from delayed treatment initiation

Some patients with HCV may benefit from delayed treatment initiation

Deuffic-Burban S. J Hepatol. 2012;57:260-266.

Aug 17 2012

Delayed initiation of treatment may be beneficial for patients with HCV detected more than 2 months after transmission, according to recent results.

Researchers designed a model to compare three treatment initiation methods in patients with acute HCV: immediate (within 2 months of transmission); early (within 3 months) and delayed (within 4 to 5 months). The model incorporated data from a separate study which evaluated outcomes in patients with acute HCV according to the presence of clinical symptoms; and a study in which the efficacy of early treatment was measured.

The likelihood of a patient achieving SVR was estimated at 92.6% with treatment initiated within 2 months of transmission, 76.5% within three months and 78.6% within 4 to 5 months. A 50% frequency of the C/C genotype was assumed, along with an increased likelihood of HCV clearance among patients with this genotype (OR=0.38) compared to those without it. Investigators used this model to estimate the probability of developing chronic HCV after 18 months under each treatment method, according to the presence of clinical symptoms and the C/C IL28B genotype.

Immediate initiation was linked to a lower probability of developing chronic HCV for both symptomatic (7.1% of those with C/C genotype, 7.3% of those without) and asymptomatic (6.6% with and 7.1% without) patients compared with delayed initiation, for which researchers estimated probabilities of 13.5% with C/C genotype and 18.0% without among symptomatic patients; and 14.6% with and 18.5% without C/C among asymptomatic patients. Higher probabilities for chronic HCV were estimated for early initiation, with 22.5% of C/C and 23.1% of non-C/C symptomatic patients developing the illness, along with 21.1% of C/C and 22.5% of non-C/C asymptomatic patients.

“Regardless of IL28B polymorphism, in asymptomatic or symptomatic patients in whom [acute HCV] is detected within 2 months of HCV transmission, it is preferable to propose immediate antiviral therapy,” the researchers wrote. “In patients in whom acute HCV transmission is detected more than 2 months after transmission, treatment 4 or 5 months later may be preferred because of higher rates of spontaneous HCV clearance after 2 months and almost similar HCV treatment efficacy between months 3 and months 4-5; again, regardless of symptomatic or non-symptomatic nature of the disease and IL28B polymorphism.”

Disclosure: See the study for a full list of relevant financial disclosures.

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