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Blood-boosting Adjuvant Therapies Can Improve Response to Interferon-based Treatment for Hepatitis C

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Use of adjuvant medications such as hormones that stimulate red and white blood cell production allowed chronic hepatitis C patients receiving pegylated interferon plus ribavirin to stay on treatment longer and increased their likelihood of achieving sustained virological response, according to a study published in the April 1, 2010 Journal of Viral Hepatitis.

Standard therapy for chronic hepatitis C virus (HCV) infection, consisting of pegylated interferon alfa-2a (Pegasys) or pegylated interferon alfa-2b (PegIntron) in combination with ribavirin for 24 or 48 weeks (depending on HCV genotype) leads to an overall sustained virological response (SVR) rate of approximately 50%.

Part of the reason for this suboptimal efficacy is that the treatment can cause difficult side effects that cause many people to reduce their drug doses or stop treatment prematurely. But several supportive, or adjuvant, therapies can help patients stay on treatment. These include:

  • Antidepressants to manage the common side effect of depression (which may be started in advance for prevention);
  • Erythropoietin (Procrit, Epogen) to increase production of red blood cells and manage anemia (a side effect of ribavirin);
  • Granulocyte colony-stimulating factor (Neupogen, Neulasta) to increase production of neutrophils, a type of white blood cell that fights infection.

W.J. Cash and colleagues from Royal Victoria Hospital in Belfast designed a study to assess the clinical impact and effect on sustained response of blood-boosting adjuvant therapies used during treatment with pegylated interferon plus ribavirin.

The analysis included 132 chronic hepatitis C patients (73% men). All but 11 participants were treatment-naive, of whom about 40% had hard-to-treat HCV genotypes 1, 4, or 6. The endpoint of interest was SVR, or continued undetectable HCV viral load 24 weeks after completion of treatment.

Results

  • 57 patients (43.8%) used adjuvant therapies. The overall sustained response rate was 66.7%, but varied according to HCV genotype:
  • Genotypes 1, 4, or 6: SVR 50.0%;
  • Genotypes 2 or 3: SVR 78.2%.
  • Among all treatment-naive participants, the SVR rate was 68.6%, again varying by genotype:
  • Genotype 1 (n = 51): 49.0%;
  • Genotypes 2 or 3 (n = 70): 82.9%.

Based on these findings, the researchers concluded, "With the use of supportive adjuvant therapy, we achieved an overall SVR of 66.7% and in treatment-naive patients 68.6%."

"In genotype 1 patients, SVR rates of up to 46% have been reported in previous studies without the use of erythropoietin and granulocyte colony-stimulating factor," they continued. "We have demonstrated the SVR for genotype 1 can be improved to 50% overall."

Investigator affiliations: Liver Unit, Royal Victoria Hospital, Belfast, UK.

6/25/10

Reference

WJ Cash, K Patterson, ME Callender, and NI McDougall. Adjuvant therapy used in conjunction with combination therapy for chronic hepatitis C improves sustained virus response rates in genotype 1 patients. Journal of Viral Hepatitis 17(4): 269-273 (Abstract). April 1, 2010.