Re: [GIWorld-Hepatitis] Retreatment of IFN/RBV or PegIFN/RBV Combination Nonresponders
- Their 50% or better SVR to Peg + ribavirin is actually doing a little
better than previously predicted, but ONLY in those who are
treatment-naive. (Which is the group of people who the predicted SVR
figures were always based on.) The problem (as always) is in those
who have done treatment before and did not respond, or who responded
but relapsed (with the non-responders being the biggest problem -
relapsers have a much greater chance of a response to another course
of treatment than non-responders.) There are two studies reported
here, one being done by Schering, and one being done by Roche. The
Schering study is further along than the Roche study.
In an earlier report from the AASLD Oct 24-28, 2003 (LONG-TERM
FOLLOW-UP OF CHRONIC HEPATITIS C PATIENTS - RESPONSE TO THERAPY AND
INCIDENCE OF LIVER-RELATED COMPLICATIONS) people who enrolled in this
study between 1996 - 1997 were followed for 5 - 7 years. This quote
is from that study: "Similarly, among 59 patients classified as
sustained virological responders (SVR) after antiviral therapy, 7
relapsed during the follow-up (12%). (editorial note: other studies
have reported 95% of patients with SVR maintain response for up to 11
years of follow-up)." So this study found a late relapse rate of
12%. However, I think it's important to consider the quality of viral
load testing that was used in 1996 and 1997. There were no tests with
the low detection levels and sensitivity of the tests used today to
determine viral response. I would guess that if the newer viral load
tests had been used to determine those peoples' viral load following
treatment that at least some of that group that later relasped would
have shown viral particles at that time, and would never have been
included in the SVR group. All recent studies have found that very
few people who are SVR at 72 weeks have relapsed at one year, and
after one year the odds of relapsing are very low. Of course, the
pegyalted interferon treatments are still relatively new, so I
imagine it will still be a while before a significant number of
long-term results are available.
As a non-responder (and genotype 1b) I am very glad to see that
finally there is more research being done for those people who fall
into this group, since up until now the focus of research has
primarily been on those who have never been on treatment before. I
wish they would break up the numbers and report exact figures for 1a
and 1b instead of lumping them together.
--- Alley <alleypat@...> wrote:
> I see they are trying to boost the ratings for pegylated? Is this__________________________________
> study funded by Schering? Just curious.
> Interesting about the 10 - 20% non responders to reg treatment
> respond svr to peg/rib.
> Sounds like their 50% or better predictions of svr responders is
> biting the dust.
> I still want to see more test results of people who are still
> undetected a year after treatment or more. I think more tests
> need to be done at this end, cuz it will give us a more accurate
> view of how treatment works. I know the companies only want to
> publish data up to the 6th mo post pcr cuz it gets the results out
> faster (and skews what I consider the real results, who lasts
> undetected and who doesn't, esp in geno 1).
> Just thinking out loud :)
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