When it comes
to the length of time that people with hepatitis C should remain on
treatment, the current consensus among medical experts is that those
strains other than genotype 1 should be treated for a total of 24
weeks.1 Of course, patients are monitored throughout treatment, and
if a predefined plunge in viral levels is seen by the 12th week of
treatment, patients are classified as having achieved an early
virologic response to therapy, or EVR.2 Those who achieve an EVR,
experts contend, are likely to achieve a sustained virologic
response, or SVR—continual undetectable levels of the virus in the
blood for at least 24 weeks following the end of treatment.2,3 Thus,
treatment for these individuals can be halted earlier in that event.
Shorter Treatment May be Possible
Now, a group of Italian doctors claims that people with the less
common genotype 2 or 3 strains of the hepatitis C virus can halt
treatment 12 weeks later if no presence of the virus has been
detected by the fourth week of therapy.4 "Twelve weeks of treatment"
for those patients "is as effective as 24 weeks," they contend.
The most common strain of HCV in the United States is genotype 1. As
many as three-quarters of HCV patients are infected with this
strain, estimates state. This strain is also more resistant to
treatment and outcomes are usually poorer than genotypes 2 and 3.
Thus, it is recommended that genotype 1 patients undergo treatment
for 48 weeks.1
The study team tested their shorter treatment hypothesis in a
clinical trial involving 283 patients infected with genotype 2 or 3
HCV. Each was randomly assigned to receive a standard 24-week
regimen of PEG-Intron (peginterferon alfa-2b) plus ribavirin. Doses
used in the study included 1 microgram of PEG-Intron per kilogram of
body weight once per week and 1000 – 1200 mg of ribavirin once per
day, based on body weight. In all, 70 patients were assigned to the
standard 24-week treatment schedule. The remaining 213 patients took
the same doses of pegylated interferon and ribavirin for either 12
or 24 weeks, depending on whether they had cleared the virus by the
fourth week of treatment. Those who had, ended treatment at week 12,
and those who didn't, continued treatment until week 24.
Early Treatment Success Noted
Among patients adhering to the standard 24-week treatment schedule,
45 of 70 (64 percent) achieved non-detectable levels of HCV by the
fourth week. That's compared to 133 of 213 patients (62 percent) in
the group taking combination therapy for either 12 or 24 weeks.
Thus, the difference between the groups was just 2%, the researchers
pointed out.
When the study team then assessed how many patients achieved an SVR
in the study, 53 of them (76 percent) in the standard duration group
did so, compared to 164 patients (77 percent) in the group given the
variable regimen. Again, the differences between the two groups were
very slight.
Benefits of Shorter Treatment
Further, "fewer patients in the variable-duration group receiving
the 12-week regimen had adverse events and withdrew [from the trial]
than in the group receiving the 24-week regimen," they wrote.
About 3 percent of the patients who received the standard 24-week
treatment duration relapsed, compared to approximately 9 percent of
those in the group with the variable treatment schedule. "Overall,
the sustained virologic response was 80% among patients with HCV
genotype 2 and 66 percent among those with genotype 3," wrote the
study group.
Based on these findings, it's apparent that "a shorter course of
therapy over 12 weeks with peginterferon alfa-2b and ribavirin is as
effective as a 24-week course for patients with HCV genotype 2 or 3
who have a response to treatment at 4 weeks," they concluded.
1. Vrolijk JM, de Knegt RJ, Veldt BJ, Orlent H, Schalm SW. The
treatment of hepatitis C: history, presence, and future. Neth J Med
2004 Mar;62(3):76-82.
2. Davis GL. Monitoring of viral levels during therapy of hepatitis
C. Hepatology 2002 Nov;36(5 Suppl 1):S145-51.
3. Fried MW. Viral factors affecting the outcome of therapy for
chronic hepatitis C. Rev Gastroenterol Disord 2004;4 Suppl 1:S8-S13
4. Mangia A, Santoro R, Minerva N et al. Peginterferon alfa-2b and
ribavirin for 12 vs 24 weeks in HCV genotype 2 or 3. N Engl J Med
2005 Jun 23;352(25):2609-17.
Be Well my
friends! Pay
attention to Your
Bodies!
