THERAPY SUCCESS RATE WITH PEGYLATED INTERFERON/RIBAVIRIN TREATMENT OF RELAPSE AND NON-RESPONDER HEPATITIS C PATIENTS
PDF

How to Cite

Fateen, F., Yousaf, M. N., Khan, N., Nouman, F., Iqbal, W., & Siraj, S. (2019). THERAPY SUCCESS RATE WITH PEGYLATED INTERFERON/RIBAVIRIN TREATMENT OF RELAPSE AND NON-RESPONDER HEPATITIS C PATIENTS. Advances in Basic Medical Sciences, 1(1). Retrieved from https://abms.kmu.edu.pk/index.php/abms/article/view/2

Abstract

Faiqa Fateen1, Muhammad Noaman Yousaf2, Niamatullah Khan1,Faisal Nouman2, Waheed Iqbal1 and Sami Siraj1*

 

1Institute of Basic Medical Sciences, Khyber Medical University, Peshawar

2Mufti Mahmood Teaching Hospital, Dera Ismail Khan

Background:  The combination therapy of Interferon and ribavirin remains the first line treatment in patients with chronic hepatitis C in Pakistan. Although the success rate of 24-week long treatment in treatment naïve patients’ genotype 3a hepatitis C patients is high, there are a few reports on retreatment of non-responder and relapse hepatitis C patients.This study was designed to assess the sustained virological response (SVR) rates in treatment-experienced patients, who had unfavorable outcome from their previous therapy.

Methodology: One hundred and thirty two (132) patients who had shown relapse (n=59) and non-response (n=73) to conventional IFN plus ribavirin were retreated with Pegylated IFN plus ribavirin. Outcomes at weak 12(early virological response [EVR]) and at week 24 (End of response [SVR]) were analyzed.

Results: One hundred and thirty two patients who had relapsed (n=59; 63%genotype3a) after previous conventional interferon plus ribavirin therapy or were nonresponders (n=73; 48% genotyp3a) were analyzed. Of the relapsers, 78% achieved an EVR and also the SVR. Of the non-responders, 81% achieved an EVR and also the SVR. SVR rates were 27% and 15% for genotype 3a and 2a respectively. EVR and low hepatitis C viral (HCV) RNA level on retreatment were associated with SVR. SVR rate for relapse and non-response patients was nearly equal.

Conclusion: Low baseline and at four weeks after start of therapy remain the most crucial predictors for treatment outcome in both relapse and non-responders. Viral genotype, on the other hand doesn’t seem to affect the therapy outcome significantly.

Key words: Chronic Hepatitis C; Pegylated Interferon plus ribavirin; Retreatment; Relapse; Nonresponders.

 

Address of corresponding author:

*Sami Siraj, PhD

Department of Pharmacology,

Institute of Basic Medical Sciences,

Khyber Medical University, Peshawar, Pakistan

samisiraj.ibms@kmu.edu.pk

PDF

References

Mühlberger N, Schwarzer R, Lettmeier B, Sroczynski G, Zeuzem S, Siebert U. HCV-related burden of disease in Europe: a systematic assessment of incidence, prevalence, morbidity, and mortality. BMC Public Health. 2009;9(1):34.

Re VL, Kostman J. Management of chronic hepatitis C. Postgraduate medical journal. 2005;81(956):376-82.

Sherman M, Shafran S, Burak K, Doucette K, Wong W, Girgrah N, et al. Management of chronic hepatitis B: consensus guidelines. Canadian Journal of gastroenterology. 2007;21(Suppl C):5C.

Zeuzem S, Buti M, Ferenci P, Sperl J, Horsmans Y, Cianciara J, et al. Efficacy of 24 weeks treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C infected with genotype 1 and low pretreatment viremia. Journal of hepatology. 2006;44(1):97-103.

Yu M-L, Dai C-Y, Huang J-F, Hou N-J, Lee L-P, Hsieh M-Y, et al. A randomised study of peginterferon and ribavirin for 16 versus 24 weeks in patients with genotype 2 chronic hepatitis C. Gut. 2007;56(4):553-9.

Ferreira SdC, Carneiro MdV, Souza FF, Teixeira AC, Villanova MG, Figueiredo JFdC, et al. Long-term follow-up of patients with chronic hepatitis C with sustained virologic response to interferon. Brazilian Journal of Infectious Diseases. 2010;14(4):330-4.

Patel K, Muir AJ, McHutchison JG. Diagnosis and treatment of chronic hepatitis C infection. Bmj. 2006;332(7548):1013-7.

Lindh M, Arnholm B, Eilard A, Farkkila M, Hellstrand K, Lagging M, et al. Hepatitis C treatment response kinetics and impact of baseline predictors. Journal of viral hepatitis. 2011;18(6):400-7.

Cariani E, Villa E, Rota C, Critelli R, Trenti T. Translating pharmacogenetics into clinical practice: interleukin (IL)28B and inosine triphosphatase (ITPA) polymophisms in hepatitis C virus (HCV) infection. Clinical chemistry and laboratory medicine : CCLM / FESCC. 2011;49(8):1247-56.

Qureshi MS, Iqbal M, Nomani AZ, Rasheed K. Time for change: conventional interferon regimes should not be the standard of care for management of Pakistani genotype-3 in chronic hepatitis C. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2014;24(1):70-2.

D'Souza R, Main J, Crossey M, Rosenberg W, Murray-Lyon IM, Hayward C, et al. Discontinuation of pegylated interferon plus ribavirin in patients who are not responding to therapy -- patients' views of early cessation of therapy. Alimentary pharmacology & therapeutics. 2005;21(1):43-7.

Umar M, Bilal M. Hepatitis C, A Mega Menace: A Pakistani Perspective. Journal of Pakistan Medical Students. 2012;2(2).

Jacobson IM, Gonzalez SA, Ahmed F, Lebovics E, Min AD, Bodenheimer HC, et al. A randomized trial of pegylated interferon α-2b plus ribavirin in the retreatment of chronic hepatitis C. The American journal of gastroenterology. 2005;100(11):2453-62.

Oze T, Hiramatsu N, Mita E, Akuta N, Sakamoto N, Nagano H, et al. A multicenter survey of re-treatment with pegylated interferon plus ribavirin combination therapy for patients with chronic hepatitis C in Japan. Hepatology research : the official journal of the Japan Society of Hepatology. 2013;43(1):35-43.

Lagging M, Rembeck K, Rauning Buhl M, Christensen P, Dalgard O, Farkkila M, et al. Retreatment with peg-interferon and ribavirin in patients with chronic hepatitis C virus genotype 2 or 3 infection with prior relapse. Scandinavian journal of gastroenterology. 2013;48(7):839-47.

Ohno O, Mizokami M, Wu R-R, Saleh MG, Ohba K-i, Orito E, et al. New hepatitis C virus (HCV) genotyping system that allows for identification of HCV genotypes 1a, 1b, 2a, 2b, 3a, 3b, 4, 5a, and 6a. Journal of clinical microbiology. 1997;35(1):201-7.

Yoshida EM, Sherman M, Bain VG, Cooper CL, Deschenes M, Marotta PJ, et al. 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. Canadian Journal of Gastroenterology. 2009;23(3):180.

Morris Sherman M, Cooper CL, Mel Krajden M, MD10 RJB. Retreatment with pegylated interferon alpha-2a and ribavirin in patients with chronic hepatitis С who have relapsed or not responded to a first course of pegylated interferon-based therapy. Can J Gastroenterol. 2009;23(3).

Pessôa MG, Cheinquer H, Almeida PR, Silva GF, Lima MPJ, Paraná R, et al. R e-treatment of previous non-responders and relapsers to interferon plus ribavirin with peginterferon alfa-2a (40KD), ribavirin±amantadine in patients with chronic hepatitis C: randomized multicentre clinical trial. Ann Hepatol. 2012;11:52-61.

Dalgard O, Bjøro K, Hellum KB, Myrvang B, Ritland S, Skaug K, et al. Treatment with pegylated interferon and ribavarin in HCV infection with genotype 2 or 3 for 14 weeks: a pilot study. Hepatology. 2004;40(6):1260-5.

Niederau C, Mauss S, Schober A, Stoehr A, Zimmermann T, Waizmann M, et al. Predictive Factors for Sustained Virological Response after Treatment with Pegylated Interferon α-2a and Ribavirin in Patients Infected with HCV Genotypes 2 and 3. PloS one. 2014;9(9):e107592.

Davis GL, Wong JB, McHutchison JG, Manns MP, Harvey J, Albrecht J. Early virologic response to treatment with peginterferon alfa‐2b plus ribavirin in patients with chronic hepatitis C. Hepatology. 2003;38(3):645-52.