HCV Response-Guided Therapy: Should Treatment Length Be Shortened or Extended?
- First Online:
The treatment of chronic HCV has traditionally been for a fixed duration based on genotype. We now recognize that patients respond to treatment along different time lines. This appears to be secondary to various clinical, histologic, and genetic host factors. The time that it requires for a patient to become HCV RNA undetectable after initiating treatment is now recognized as one of the most important determinants of sustained virologic response. This information can be used to adjust the duration of peginterferon and ribavirin, either shorter or longer, and allows therapy to be tailored to the specific needs of each patient. This concept is referred to as response-guided therapy.
KeywordsChronic hepatitis C virus Interferon treatment IL28B Sustained virologic response
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.• McHutchison JG, Lawitz EJ, Shiffman ML, et al.: Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection. N Engl J Med 2009; 361:580–593. This article describes the largest study ever conducted comparing two types of peginterferon and a lower dose of peginterferon α-2b.Google Scholar
- 10.•• Ge D, Fellay J, Thompson AJ, et al.: Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature. 2009; 461:399-401. This study demonstrates the impact of the IL28B gene on sustained response and the distribution of this gene across various racial and ethnic groups.Google Scholar
- 27.von Wagner M, Huber M, Berg T, et al.: Peginterferon-alpha-2a (40KD) and ribavirin for 16 or 24 weeks in patients with genotype 2 or 3 chronic hepatitis C. Gastroenterology. 2005; 129:522–527.Google Scholar
- 30.• Shiffman ML, Suter F, Bacon BR, et al.: Peginterferon alfa-2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3. N Engl J Med. 2007; 357:124–134. This article describes the largest study ever conducted evaluating the impact of a shorter duration of therapy in patients with chronic HCV genotypes 2 and 3.Google Scholar
- 34.•• Thompson AJ, Muir AJ, Sulkowski MS, et al.: IL28B polymorphism improves viral kinetics and is the strongest pre-treatment predictor of SVR in HCV-1 patients. Gastroenterology. 2010; 139:120–129. This study shows the impact of the IL28B gene on virologic response patterns and the impact of this on SVR.Google Scholar
- 35.• McHutchison JG, Manns MP, Muir AJ, et al.: Telaprevir for previously treated chronic HCV infection. N Engl J Med. 2010; 362:1292–1303. This article describes a phase 2 clinical trial showing the impact of retreating prior HCV treatment failures to peginterferon and ribavirin with peginterferon, ribavirin, and telaprevir.Google Scholar
- 36.Bacon BR, Gordon SC, Lawitz E, et al.: HCV respond-2 final results: High sustained virologic response among genotype 1 previous non-responders and relapsers to peginterferon/ribavirin when retreated with boceprevir plus peginterferon alfa-2b/ribavirin. Hepatology 2010; 52 (suppl);430A.Google Scholar
- 40.• Shiffman ML, Salvatori J, Hubbard S, et al.: Treatment of chronic hepatitis C virus genotype 1 with peginterferon, ribavirin, and epoetin alpha. Hepatology. 2007; 46:371–379. The only prospective, randomized, controlled trial conducted to date to evaluate the impact of epoetin α versus dose modification on sustained virologic response in patients with chronic HCV being treated with peginterferon and ribavirin.Google Scholar
- 41.•• Sulkowski MS, Shiffman ML, Afdhal NH, et al.: HCV treatment-related anemia is associated with higher sustained virologic response rate. Gastroenterology. 2010; 139:1602–1611. This article presents a retrospective analysis from a large clinical trial evaluating the impact of dose reduction to epoetin α for treatment of anemia in patients with chronic HCV who are receiving peginterferon and ribavirin.Google Scholar