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Patients’ early HCV RNA response to antiviral therapy may predict long-term outcome

Issue: May 2009

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Viral kinetic response at 24 to 28 hours after the first dose of peginterferon and ribavirin may predict the ultimate antiviral efficacy in patients with hepatitis virus C, according to results of a multi-center study conducted in the United States. Significant differences between the response rates in black and white patients also were observed.

There were 341 patients with hepatitis virus C (HCV) in the study. All patients received peginterferon alfa-2a (Pegasys, Roche) at 180 mcg per week and daily ribavirin (Copegus, Roche) at 1,000 mg for patients weighing <75 kg and 1,200 mg for patients weighing .75 kg. The researchers assessed the decrease from baseline in HCV RNA levels at three time points. The first phase was at 24 to 28 hours after dosing, the second phase was defined as the maximum weekly decrease in HCV RNA levels between days seven and 28 or between days 14 and 28; the third phase was the total decrease by week 28.

There were 154 black patients and 187 white patients.

At first-phase evaluation, the average decrease in HCV RNA levels was 0.75 log₁₀ IU/mL. The decrease was 0.89 log₁₀ IU/mL among white patients and 0.60 log₁₀ IU/mL among black patients (P<.01). For the second phase, the decrease was 0.55 log₁₀ IU/mL per week among whites and 0.38 log₁₀ IU/mL per week among blacks (P<0.01). At the final evaluation, the decrease was 2.56 log₁₀ IU/mL for whites and 1.31 log₁₀ IU/mL for blacks.

Sustained virological response was predicted by viral kinetics at all three time points. The area under the curve was 0.876 at the second evaluation and 0.879 at the third evaluation, compared with 0.806 at the first evaluation (P<.001 for both comparisons).

Hoofnagle J. J Infect Dis. 2009;199:1112-1120.