Virological response in patients with hepatitis C virus genotype 1b and a high viral load: impact of peginterferon-alpha-2a plus ribavirin dose reductions and host-related factors

• Published in: Clinical drug investigation 2008, Vol.28 (1), p.9
• Main Authors: Yamada, Gotaro, Iino, Shiro, Okuno, Tadao, Omata, Masao, Kiyosawa, Kendo, Kumada, Hiromitsu, Hayashi, Norio, Sakai, Takahiro
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antiviral Agents - administration & dosage; Antiviral Agents - therapeutic use; Clinical Trials, Phase III as Topic; Databases, Factual; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Genotype; Hepacivirus - drug effects; Hepacivirus - genetics; Hepatitis C - blood; Hepatitis C - drug therapy; Hepatitis C - virology; Host-Pathogen Interactions; Humans; Injections, Subcutaneous; Interferon-alpha - administration & dosage; Interferon-alpha - therapeutic use; Japan; Male; Middle Aged; Polyethylene Glycols - administration & dosage; Polyethylene Glycols - therapeutic use; Randomized Controlled Trials as Topic; Recombinant Proteins; Retrospective Studies; Ribavirin - administration & dosage; Ribavirin - therapeutic use; RNA, Viral - blood; RNA, Viral - isolation & purification; Time Factors; Treatment Outcome; Viral Load
• ISSN: 1173-2563
• DOI: 10.2165/00044011-200828010-00002

In Japan the prevalence of the hepatitis C virus (HCV) antibody is highest in the elderly population. Therefore, it is important for elderly patients to undergo interferon (IFN) therapy. In patients with HCV genotype 1b and a high viral load, the sustained virological response (SVR) rate is lower in older compared with younger patients receiving combination antiviral therapy. In addition, inadequate adherence to combination therapy is often seen in elderly patients, and is associated with reduced response rates. The aim of this retrospective analysis was to evaluate the effects of host-related factors (i.e. sex, age, baseline HCV RNA level, bodyweight and fibrosis stage) and peginterferon (PEG IFN)-alpha-2a plus ribavirin dose reductions on SVR rates. A total of 192 treatment-naive patients with a HCV genotype 1b infection and a high viral load were included in the analysis. Patients had been enrolled into a phase III trial of 48 weeks of treatment with PEG IFN-alpha-2a plus ribavirin or PEG IFN-alpha-2a plus placebo. All patients were evaluated for effect of drug exposure on SVR. In addition, the impact of host-related factors or dose reductions on SVR was assessed. Approximately 30% of patients were considered elderly (> or =60 years of age). The overall SVR rate was significantly higher in patients treated with combination therapy versus monotherapy (59.4% vs 24.0%, p < 0.001). Attainment of an SVR following combination therapy was not influenced by any factor evaluated in the analysis, although elderly males were associated with decreased SVR rates. Younger age (odds ratio [OR] 1.081; 95% CI 1.125, 1.034; p = 0.0009), lower baseline HCV RNA levels (OR 1.003; 95% CI 1.006, 1.001; p = 0.006) and a severe fibrosis stage (F3/4) [OR 6.194; 95% CI 1.037, 37.000; p = 0.0455] significantly increased the likelihood of achieving an SVR with monotherapy. In the combination therapy group, patients maintaining a full dosage schedule of PEG IFN-alpha-2a and ribavirin and those requiring dose reductions of either study drug had similar SVR rates (64.5% vs 61.9%). However, the SVR rate was reduced to 33.3% among patients who discontinued combination therapy. Three out of the 31 patients who received the full dosage schedule were elderly patients. In addition, of the 15 patients who discontinued combination therapy, three were or =60 years of age. The SVR rate was reduced in patients with cumulative PEG IFN-alpha-2a and ribavirin doses o