The clinical features and treatment outcome of chronic hepatitis C with pegylated interferon and ribavirin in routine care
- Author:
Soek Siam Tan
;
Adlin Nadia Zakaria
- Publication Type:Original Article
- Keywords:
Hepatitis C;
“real world”;
pegylated interferon and ribavirin;
sustained virological response;
adverse events
- From:
The Medical Journal of Malaysia
2017;72(3):165-174
- CountryMalaysia
- Language:English
-
Abstract:
Aim: To describe the clinical characteristic of hepatitis C
(HCV) patients and the results of pegylated interferon and
ribavirin (PegIFN/RBV) therapy in a routine clinical practice.
Methods: A retrospective review of consecutive HCV
patients treated with PegIFN/RBV in 2004 to 2012.
Results: A total of 273 patients received treatment. The mean
age was 44.16 ± 10.5 years and 76% were male. The top 2
self-reported risks were blood or blood product transfusion
before 1994 and injection drug use, found in 57.1% of
patients. The predominant HCV genotype (GT) was 3 at
60.6%, second was GT1 at 36.1% and other GTs were
uncommon at about 1% or less. About half of our patients
have high baseline viral load (>800,000 iu/ml), 18.3% had
liver cirrhosis and 22.3% had HIV co-infection. Co-morbid
illness was found in 42.9%, hypertension and type 2
diabetes were the two most common. The overall sustained
virological response (SVR) by intention-to-treat analysis
were 54.9% (n=150/273), 41.2% (40/97) for GT1, 100% (5/5) for
GT2 and 62% (101/163) for GT3. Subgroup analysis for HCV
monoinfected, treatment naïve showed SVR of 49.2% (31/63)
for GT1, 100% (5/5) for GT2 and 67% (69/103) for GT3. In HCV
mono-infected and treatment experienced (n=29), the SVR
was 28.6% (4/14) for GT1, 21.4% (69/103) for GT3. In the
HIV/HCV co-infected, treatment naïve (n=56), the SVR was
28.6% (4/14) for GT1 and 64.3% (27/42) for GT3. Treatment
naïve GT3 mono-infected patients had a statistically
significant higher SVR compared to treatment experienced
patients (P=0.001). In GT3 patients who achieved rapid
virological response, the SVR was significantly higher at
85.2% (P< 0.001). The SVR for cirrhotics were low especially
for GT1 at 21% (4/19) and 31% (4/13) based on all patients
and treatment naïve HCV monoinfected respectively. In GT3
cirrhotics the corresponding SVR were 57.1% (16/28) and
60.9% (14/23). Premature discontinuation rate was 21.2%
with the majority due to intolerable adverse events at 12.1%.
Conclusions: In our routine clinical practice, the HCV
patients we treated were young, predominantly of GT3 and
many had difficult-to-treat clinical characteristics. The SVR
of our patients were below those reported in Asian clinical
trials but in keeping with some “real world” data.
