American Thoracic Society: Digestive Disease Week 2007
Pegylated Interferon with or without Ribavirin for Hepatitis C Viral Infection
Presenter: Mark G. Swain, MD, Professor, Department of Medicine, Gastrointestinal Research Group, University of Calgary, Canada
Because clinical relapse is rare in patients with chronic hepatitis C virus (HCV) infection who achieve a sustained viro-logical response (SVR) with peginterferon alfa-2a (Pegasys), with or without ribavirin (Copegus), both manufactured by Roche, it is possible that these patients might be considered “clinically cured.”
Dr. Swain noted that SVR rates of up to 66% have been reported with peginterferon alfa-2a (40 kd) plus ribavirin in patients with HCV alone and of 40% in patients co-infected with HCV and human immunodeficiency virus (HIV). Pegasys is a modified form of interferon with a 40-kD polyethylene gly-col strand attached to a recombinant interferon. This formulation increases the product’s half-life from 7-10 hours to 77 hours.
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The overall durability of these sustained responses, however, is less well known. To quantify the long-term durability of responses with peginterferon alfa-2a (40 kd), given as monotherapy or with ribavirin, Dr. Swain evaluated 997 patients who achieved undetectable HCV RNA levels (below 50 IU/mL) at 24 weeks’ follow-up in nine randomized, multicenter trials of peginterferon alfa-2a (40 kd) therapy for HCV infection. Three trials involved monotherapy, and six involved combination therapy. Patients underwent five years of annual follow-up serum testing of HCV RNA levels. Ninety-three of the patients, all of whom received combination therapy, had HIV co-infection.
At a mean follow-up of 4.1 years, response rates were durable in 99.2% of patients. HCV RNA levels were detectable in eight patients.
Analyzing the type and duration of therapy, the incidence of co-infection, age, sex, race, genotype, viral load, days off treatment, and the presence of cirrhosis (none), Dr. Swain observed no suggestion of common risk factors. It was unclear whether the eight patients whose HCV RNA viral load became detectable during follow-up had experienced re-infection or a virological relapse.
He concluded that patients who achieve a sustained response could be considered cured of chronic HCV. cialis canadian pharmacy
Peginterferon alfa-2b and Peginterferon alfa-2a
Presenter: Vinod K. Rustgi, MD, Clinical Professor of Medicine, Georgetown University, Washington, DC
In a poster presented by Dr. Rustgi, patients with HCV who were intolerant of peginterferon alfa-2b (Peg-Intron, Schering) plus ribavirin, because of flu-like symptoms, fatigue, injection-site reactions, or depression, were more likely to tolerate peginterferon alfa-2a (Pegasys) plus ribavirin (96% completed 36 weeks of treatment). As a result, they achieved higher sustained virological response rates in a multicenter trial compared with non-responders.