Advanced fibrosis is not a negative pretreatment predictive factor for genotype 2 or 3 chronic hepatitis C patients

Clin Mol Hepatol. 2013 Jun;19(2):148-55. doi: 10.3350/cmh.2013.19.2.148. Epub 2013 Jun 27.

Advanced fibrosis is not a negative pretreatment predictive factor for genotype 2 or 3 chronic hepatitis C patients.

Lee HS, Kweon YO, Tak WY, Park SY, Kang EJ, Lee YL, Yang HM, Park HW.

Source
Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu, Korea.

Abstract
BACKGROUND/AIMS:

Chronic hepatitis C patients with advanced fibrosis have unsatisfactory sustained virological response (SVR) rates. Few data demonstrating the efficacy of combination therapy in chronic hepatitis C patients with advanced fibrosis in South Korea are available. The purpose of this study was to assess whether the stage of fibrosis impacts the efficacy of combination therapy for chronic hepatitis C.

METHODS:
We retrospectively reviewed data for a total of 109 patients with chronic hepatitis C, treated with peginterferon alfa and ribavirin. SVR according to the stage of liver fibrosis assessed by pretreatment liver biopsy and genotype results were analyzed.

RESULTS:
Data from 66 genotype 1 patients (60.6%) and 43 genotype 2 or 3 patients (39.4%) among the 109 patients were analyzed. SVR rates for the genotype 1 patients were significantly lower for the stage 3-4 group (32.1%) than the stage 0-2 group (78.9%; P<0.001). SVR rates (92.0% for stage 0-2, 77.8% for stage 3-4, P=0.184) of genotype 2 or 3 patients were not significantly different according to fibrosis stage. Likewise, the frequency of adverse events was not significantly different according to fibrosis stage.

CONCLUSIONS:
Compared to patients without advanced fibrosis, we can anticipate good SVR rates for genotype 2 or 3 patients with advanced fibrosis and they did not show an inferior tolerability for peginterferon and ribavirin combination therpy. Our results suggest that active treatment is needed for genotype 2 or 3 patients with advanced fibrosis.

KEYWORDS:
Advanced fibrosis, Genotype, Hepatitis C

INTRODUCTION
More than 170 million people are infected with hepatitis C virus (HCV) worldwide.1 Approximately 25% of all cirrhosis and hepatocellular carcinoma cases are attributable to chronic hepatitis C infection. 2 The prognosis of HCV infection varies according to fibrosis progression, and patients most in need of treatment are chronic hepatitis C with advanced fibrosis or cirrhosis.3 Combination therapy with peginterferon and ribavirin is the optimal treatment for chronic hepatitis C.4 However, antiviral treatment of chronic hepatitis C with advanced fibrosis or cirrhosis is challenging because of frequent comorbidities that affect patient adherence to the scheduled therapies, the risk of adverse events related to therapy, and hyporesponsiveness to peginterferon due to still poorly identified mechanisms.5 Chronic hepatitis C patients with cirrhosis have unsatisfactory sustained virological response (SVR) rates.6 Achieving acceptable SVR rates in these patients significantly reduces the incidence of long-term complications such as hepatic decompensation, development of hepatocellular carcinoma, and death.7 Active treatment of chronic hepatitis C patients with advanced fibrosis is thus very important for preventing such complications.8

However, few data are available on the efficacy of combination therapy in chronic hepatitis C patients with advanced fibrosis in South Korea.6,9

The purpose of this study was to assess whether the stage of fibrosis impacts the efficacy of combination therapy for treating chronic hepatitis C.

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