Retreatment with pegylated interferon alpha-2a and ribavirin in patients with chronic hepatitis C who have relapsed or not responded to a first course of pegylated interferon-based therapy
EM Yoshida | M Sherman | VG Bain | CL Cooper | M Deschênes | PJ Marotta | SS Lee | M Krajden | H Witt-Sullivan | RJ Bailey | C Usaty | K Peltekian | on behalf of the Canadian Pegasys Study Group
BACKGROUND: Pegylated interferon (pegIFN) and ribavirin combination
therapy remains the first-line treatment for chronic hepatitis
C virus (HCV) infection. In contrast to the wealth of studies in
treatment-naive patients, the effectiveness of retreatment in patients
who have previously failed pegIFN-based therapy is largely unreported.
AIM: To assess the effectiveness of the retreatment of patients who
have previously failed an initial course of pegIFN-based therapy with
pegIFNα-2a and ribavirin.
METHODS: A post-hoc analysis of a multicentre open-label study
was performed. Patients received pegIFNα-2a and ribavirin at a dose of
800 mg/day and later 1000 mg/day to 1200 mg/day for 24 to 48 weeks at
the discretion of the investigator. Outcomes at week 12 (early virological
response [EVR]) and week 24 (sustained virological response
[SVR]) were analyzed.
RESULTS: Eighty-seven patients who had relapsed after previous
pegIFN-based therapy (n=28; 78% genotype 1) or were nonresponders
(n=59; 71% genotype 1) were analyzed. Of the relapsers, 86%
achieved an EVR and 68% achieved an SVR. In relapsers to pegIFN
monotherapy (n=15) or pegIFN plus ribavirin (n=13), 60% and 77%
achieved an SVR, respectively. Fibrosis and genotype did not affect
the likelihood of SVR in relapsers although this may be the result of
the relatively small number of patients. In previous nonresponders, an
EVR was achieved in 53% but an SVR occurred in only 17%. In
nonresponders to pegIFN monotherapy (n=9) and pegIFN plus ribavirin
(n=50), 33% and 14% achieved an SVR, respectively. Genotype
did not affect SVR in nonresponders. Only 10% with a METAVIR
score of F3 or F4 on liver biopsy achieved an SVR.
CONCLUSIONS: Relapse after previous pegIFN-based therapy is
associated with a strong probability of treatment success whereas
retreatment of those with previous nonresponse does not.