Topic: Current treatment - Pegasys
W1013. Predictive factors of sustained
virological response to peginterferon alpha-2a therapy in the patients with
chronic hepatitis C despite the discontinuation of peginterferon alpha-2a
therapy due to adverse events.
K. Sato; K. Hosonuma;
T. Itikawa; S. Kakizaki; H. Takagi; M. Mori
Background:
Interferon (IFN) therapy in the patients with chronic
hepatitis C is occasionally discontinued due to various adverse events and ends
up failing. However we encounter the patients who achieved sustained
virological response (SVR) despite the discontinuation of IFN due to adverse
events. We herein clarify predictive factors of SVR to peginterferon alpha-2a
therapy in the cases of chronic hepatitis C despite the discontinuation of
peginterferon alpha-2a therapy due to adverse events.
Methods:
Thirty-two patients with the discontinuation of peginterferon
alpha-2a due to adverse events such as depression and appetite loss were
enrolled in this study. The cases with the intended short periods of
peginterferon alpha-2a therapy were excluded. The
definition of the discontinuation of peginterferon alpha-2a is that
peginterferon alpha-2a is discontinued at least four weeks shorter than the
standard therapies (48 weeks) which are approved in
Results:
SVR and Non-SVR (NR) were achieved in 14 and 16 cases,
respectively. The sex ratio (M/F) in the cases with SVR and NR was 7/7 and
3/13, respectively. The average age in the cases with SVR and NR were 59 years
(range 25-74) and 59 (range 49-74), respectively. The average periods of
peginterferon alpha-2a therapy in the cases with SVR and NR were 21 (range
5-32) and 16 weeks (range 2-38), respectively.
Average pretreatment serum HCV-RNA in the cases with SVR and
NR was 183 (range 4-1760) and 869 (range 15-2100) KIU/ml, respectively. The HCV
genotypes included 1b (n = 4 and 7), 2a (n = 8 and 4) and 2b (n = 2 and 5) in
the patients achieving SVR and NR, respectively. The numbers of the patients
achieving SVR and NR with serum HCV-RNA level below 0.5KIU/ml within 4 weeks
after peginterferon alpha-2a therapy were all 14 and 5, respectively. Univariate
analysis showed pretreatment serum HCV-RNA level and the periods of
disappearance of serum HCV-RNA were significant predictive factors of SVR. In
addition, by multivariate analysis, pretreatment serum HCV-RNA level (p=0.0059)
and the periods of disappearance of serum HCV-RNA (p=0.0004) were independent
predictors of SVR in all patients.
Conclusions:
Pretreatment serum HCV-RNA level and the periods of
disappearance of serum HCV-RNA behave as predictive factors of SVR to
peginterferon alpha-2a therapy in the patients with chronic hepatitis C. Thus,
these factors may enable us to shorten the periods of peginterferon alpha-2a
therapy by design.
Topic: Current HCV
Treatment – General
W1150. Antiviral treatment in Crohn ’s patients with chronic hepatitis C is well tolerated
and effective.
T. Scherzer; K.
Staufer; C. Gurguta; G. Novacek; P. Ferenci; H. Vogelsang
Introduction:
Due to surgery and/or blood transfusions patients with Crohn ’s disease (CD) are at risk to be infected with
hepatitis C. The potential side effect profile of antiviral combination therapy
in patients with CD is unknown. Therefore hepatitis C is rarely treated in CD.
Aim:
was to analyze the efficacy and
tolerability of antiviral IFN/ribavirin therapy in patients with CD. End of
treatment response (ETR) and sustained virologic response (SVR; undetectable
virus PCR at 6 month follow up) rates, were evaluated.
Methods:
Nine CD patients (29-56a; f:5,m:4; colon disease: 1, ileum
disease: 2, ileocolon disease: 6; disease duration: mean 23.4a (range 5-33) and
hepatitis C (genotype 1:7, 1 with genotype 3:1, unknown:1) received either
interferon α-2b monotherapy (n=2) or 180µg/week peginterferon α-2a
(PEGASYS®, Roche,
Results:
Of the 9 patients, 8 have finished treatment. All 8 had an
ETR; the remaining patient is HCV-RNA negative on therapy. So far, 6 patients
completed follow up, 4 achieved a SVR, 2 relapsed.
Overall, therapy was well tolerated. Due to mildly increased
CD activity (rise of α1-acid glycoprotein: n=5; diarrhea: n=4, increased
CRP: n=1) CD specific treatment was modified in 5 (55%) patients, including 3
requiring glucocorticoids (2 per os, 1 topical). One patient received
antibiotics for exacerbation of preexisting fistula. No clinically significant
major flares in CD activity were noted.
The typical side effects of antiviral therapy required the
administration of hemopoetic growth factors: four patients became anemic (Hb
≤8.1 mg/dl) and were treated with erythropoetin, one patient received
filgrastim because of neutropenia. CDAI was similar at BL (10.5 – 86.8) and 1
months after end of antiviral treatment (45 - 103). Due to the typical side
effects of antiviral therapy (haematocrit decrease, fever, arthralgia, reduced
general condition, loss of weight) the CDAI cannot be assessed during
treatment.
Conclusion:
Hepatitis C treatment is effective and well tolerated in CD
patients. Since immunosuppression favours progression of chronic hepatitis C,
antiviral combination therapy should be offered to patients with inactive CD.