Clinical

24 weeks of peg-interferon/ribavirin best for treating HCV genotypes 2 and 3

Last Updated: 2007-07-11 17:00:10 -0400 (Reuters Health)

By Megan Rauscher

NEW YORK (Reuters Health) - In patients infected with hepatitis C virus (HCV) genotype 2 or 3, the standard 24-week course of peg-interferon alfa-2a and ribavirin produces a greater overall sustained virologic response rate than a shortened 16-week course.

That's according to a study in which 1,469 patients with HCV type 2 or 3 were randomized to 180 micrograms peg-interferon alfa-2a weekly plus 800 mg ribavirin daily for 16 or 24 weeks.

"The sustained virologic response rate was significantly lower in patients treated for 16 weeks than in patients treated for 24 weeks (62% versus 70%)," the study team reports in the July 12 issue of The New England Journal of Medicine.

"One of the most important factors in determining the likelihood of sustained virologic response when treating a patient with chronic HCV with peg-interferon and ribavirin is how fast the patient responds," study leader Dr. Mitchell L Shiffman noted in comments to Reuters Health. Dr. Shiffman is chief of hepatology and medical director of the liver transplant program at Virginia Commonwealth University Medical Center in Richmond.

"Approximately 66% of patients with HCV genotypes 2 and 3 are already HCV RNA undetectable within 4 weeks after initiating treatment," he explained.

"The current study demonstrates that if this treatment is then continued for a total of 24 weeks, approximately 90% will achieve a sustained virologic response," he added. Reducing the duration of treatment is still associated with a "good sustained virologic response -- seen in about 75% of patients."

However, Dr. Shiffman noted, reducing the duration of treatment is associated with a higher relapse rate - 31% in the 16-week treatment arm versus 18% in the 24-week treatment arm.

Thus, it's Dr. Shiffman's opinion that "if patients with genotypes 2 or 3 are tolerating HCV treatment well, they will do the best if they complete 24 weeks of treatment and should not be eager to reduce the duration of therapy."

N Eng J Med 2007;357:124-134.