Determinants of relapse after a short (12 weeks) course of antiviral therapy and re-treatment efficacy of a prolonged course in patients with chronic hepatitis C virus genotype 2 or 3 infection

December 22, 2008

Hepatology. 2008 Oct 9. [Epub ahead of print]

Determinants of relapse after a short (12 weeks) course of antiviral therapy and

re-treatment efficacy of a prolonged course in patients with chronic hepatitis C

virus genotype 2 or 3 infection.

Mangia A, Minerva N, Bacca D, Cozzolongo R, Agostinacchio E, Sogari F, o G,

Vinelli F, Ricci GL, Romano M, Carretta V, Petruzzellis D, Andriulli A.

Liver Unit, IRCCS " Casa Sollievo della Sofferenza, " San Giovanni Rotondo, Italy.

In hepatitis C virus (HCV) genotypes 2 and 3 patients, the high rate of relapse

after 12 to 16 weeks of antiviral therapy is the main concern for shortening

treatment duration. This study was undertaken to delineate predictors of relapse

after short treatment in patients with undetectable HCV RNA at treatment week 4

(RVR), and to report in RVR patients with relapse the sustained virological

response (SVR) after a second 24-week course of therapy. RVR patients received

pegylated interferon (Peg-IFN) alfa-2b (1.5 mug/kg) and ribavirin (1000-1200

mg/day) for 12 weeks; those who relapsed were re-treated with the same drug

doses but for the extended standard duration of 24 weeks. Logistic regression

analysis was applied to delineate predictors of relapse by using age, sex, route

of transmission, body mass index (BMI), serum alanine aminotransferase (ALT),

HCV genotypes, serum HCV RNA levels, and platelet counts as covariates. Of 718

patients with genotypes 2 and 3 who were started on therapy, 496 (69.1%) had

undetectable HCV RNA at week 4. Of them, 409 patients (82.5%, CI 79.1-85.8)

attained SVR, and 67 (14.1%, CI 10.4-16.5) relapsed. At regression analysis,

only platelet count less than 140,000 mm(3) [odds ratio, 2.51; confidence

interval (CI), 1.49-4.20] and BMI 30 or higher (odds ratio, 1.7; CI, 1.03-2.70)

were independently associated with relapse. Forty-three of 67 patients with

relapse agreed to be re-treated, and an SVR was achieved in 30 (70.0%) of them.

Conclusion: We recommend 12 weeks course of therapy for patients with

undetectable HCV RNA at treatment week 4, providing they present with no

advanced fibrosis and low BMI. (HEPATOLOGY 2008.).

PMID: 19072829 [PubMed - as supplied by publisher]

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