Using early viral kinetics to predict antiviral outcome in response-guided pegylated interferon plus ribavirin therapy among patients with hepatitis C virus genotype 1 |
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Authors: | Tsugiko Oze Naoki Hiramatsu Takayuki Yakushijin Masanori Miyazaki Sadaharu Iio Masahide Oshita Hideki Hagiwara Eiji Mita Yoshiaki Inui Taizo Hijioka Masami Inada Shinji Tamura Harumasa Yoshihara Atsuo Inoue Yasuharu Imai Takuya Miyagi Yuichi Yoshida Tomohide Tatsumi Tatsuya Kanto Akinori Kasahara Norio Hayashi Tetsuo Takehara |
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Institution: | 1. Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan 2. Higashiosaka City Central Hospital, Higashiosaka, Japan 3. Osaka Police Hospital, Osaka, Japan 4. Kansai Rousai Hospital, Amagasaki, Japan 5. National Hospital Organization Osaka National Hospital, Osaka, Japan 6. Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan 7. National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Japan 8. Toyonaka Municipal Hospital, Toyonaka, Japan 9. Minoh City hospital, Minoh, Japan 10. Osaka Rousai Hospital, Sakai, Japan 11. Osaka General Medical Center, Osaka, Japan 12. Ikeda Municipal Hospital, Ikeda, Japan 13. Department of General Medicine, Osaka University Hospital, Suita, Japan
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Abstract: | Background HCV kinetics during treatment demonstrated strong association with the antiviral outcome of patients treated with pegylated interferon (Peg-IFN) plus ribavirin. However, the relationship between HCV kinetics and pre-treatment factors remains unclear. Methods Of 547 patients with HCV genotype 1 treated with Peg-IFN alfa-2b plus ribavirin, 401 completed the response-guided therapy and were assessed for per protocol analysis. Results The sustained virologic response (SVR) rate was 53 % for all patients, 60 % for those with genotype TT, and 19 % for those with genotype TG/GG according to IL28B (rs8099917) single nucleotide polymorphisms. The SVR rates increased with HCV decrease at week 4; 4 % (2/56) with <1 log10 decrease, 13 % (7/56) with 1–2 log10 decrease, 51 % (44/87) with 2–3 log10 decrease, 64 % (56/87) with 3–4 log10 decrease, 88 % (72/82) with more than 4 log10 decrease but with detectable HCV RNA and 100 % (33/33) with undetectable HCV RNA (p < 0.001). Similarly, SVR rates increased step-by-step in proportion to HCV decrease in both IL28B TT and TG/GG groups, showing almost the same SVR rates for the same conditions. In multivariate analysis, age (p = 0.005) and the magnitude of HCV decrease at week 4 (p < 0.001) but not IL28B were associated with SVR. Advanced liver fibrosis (p = 0.004) and the magnitude of HCV decrease at week 4 (p < 0.001) but not IL28B were associated with non-response. Conclusions The magnitude of the HCV decrease at week 4 seems to be the most reliable marker for predicting antiviral outcome after starting Peg-IFN plus ribavirin therapy. |
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