, Volume 7, Issue 2, pp 64-71
Date: 29 May 2008

Optimizing therapy in treatment-naïve genotype 1 patients

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With the current standard dose and duration of pegylated interferon (PEG-IFN) and ribavirin (RBV), a sustained virologic response (SVR) is obtained in about 40% to 45% of patients with hepatitis C virus genotype 1. Few baseline characteristics can be modified to enhance response rates, so the focus of recent studies has been on whether increasing the dose and duration of treatment can improve SVR rates. Emerging data support consideration of higher-dose RBV and possibly higher doses of PEG-IFN. Additionally, for those not achieving a complete early virologic response, extending treatment from 48 to 72 weeks reduces relapse rates and improves sustained responses. Adherence remains an important “on-treatment factor” influencing responses, but studies are inconsistent in terms of what the “critical” cutoff for dose reductions is. At present, the best strategy to maximize SVR rates for genotype 1 and other “difficult-to-treat” populations includes determining whether any baseline factors can be modified before treatment, maximizing adherence, considering use of higher drug doses, and adjusting treatment duration based on early virologic responses.