Loading ...
Sorry, an error occurred while loading the content.

Lower-Dose Therapy Controls HCV

Expand Messages
  • scarletpaolicchi
    Lower-Dose Therapy Controls HCV Download Complimentary Source PDF By Charles Bankhead, Staff Writer, MedPage Today Published: August 05, 2009 Reviewed by
    Message 1 of 1 , Aug 6, 2009
    • 0 Attachment
      Lower-Dose Therapy Controls HCV
      Download Complimentary Source PDF
      By Charles Bankhead, Staff Writer, MedPage Today
      Published: August 05, 2009
      Reviewed by Zalman S. Agus, MD; Emeritus Professor
      University of Pennsylvania School of Medicine and
      Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

      http://www.medpagetoday.com/InfectiousDisease/Hepatitis/15388

      * Explain to patients that in this study a low-dose antiviral therapy for
      hepatitis C infection proved as effective as standard-dose therapy.

      Hepatitis C (HCV) therapy based on low-dose peginterferon alpha-2b (Peg-Intron)
      achieved a sustained virologic response rate and tolerability comparable to a
      higher dose of alpha-2b and peginterferon alpha-2a (Pegasys), a multicenter
      clinical trial found.

      Rates of sustained virologic response ranged from 38% to 41% among the three
      regimens. Relapse rates were similar among the three treatment groups, and
      serious adverse events occurred in 9% to 12% of patients in each group.

      The findings came as a surprise, given evidence of a higher rate of sustained
      response in patients treated with standard-dose peginterferon alpha-2b.

      "We aimed to test the hypothesis that use of standard-dose peginterferon
      alpha-2b with ribavirin would result in a higher rate of sustained virologic
      response than with the low-dose regimen," John G. McHutchison, MD, of Duke
      University in Durham, N.C., and colleagues reported in the Aug. 6 New England
      Journal of Medicine.

      "Although our data do not support this hypothesis, a significant interaction
      between treatment group and sex suggests that women may have higher rates of
      sustained virologic response with standard-dose than with low-dose peginterferon
      alpha-2b."

      Treatment guidelines for hepatitis C infection recommend peginterferon alpha-2a
      or alpha-2b in combination with ribavirin. However, comparative data on the two
      therapies have been scant.

      In an effort to clarify their relative effectiveness and safety, investigators
      at 118 sites in the U.S. randomized 3,070 patients with HCV genotype 1 to one of
      three treatment groups:

      * peginterferon alpha-2b at a standard dose of 1.5mcg/kg/week plus ribavirin
      800 to 1400 mg/d
      * peginterferon alpha-2b at a low dose of 1.0 mcg/kg/week plus ribavirin 800
      to 1400 mg/d
      * peginterferon alpha-2a at a dose of 180 mcg/week plus ribavirin 1000 to
      1200 mg/d

      Randomized treatment continued for a maximum of 48 weeks, and patients were
      followed for an additional 24 weeks.

      The primary endpoint was sustained virologic response, defined as undetectable
      HCV RNA 24 weeks after completion of therapy.

      When the study ended, rates of sustained virologic response were 38% with
      low-dose peginterferon alpha-2b, 39.8% with standard-dose alpha-2b, and 40.9%
      with peginterferon alpha-2a.

      Relapse rates were 20% with low-dose peginterferon alpha-2b, 23.5% with
      standard-dose alpha-2b, and 31.5% for peginterferon alfa-2a.

      Overall, patients who had undetectable HCV RNA levels after four and 12 weeks of
      treatment had sustained virologic response rates of 86.2% and 78.7%,
      respectively.

      Higher ribavirin doses were associated with an increased likelihood of sustained
      virologic response in all three treatment groups, the authors said.

      Patients who weighed 75 to 85 kg received 1000 mg of ribavirin if they were
      randomized to peginterferon alpha-2b and 1200 mg if they received peginterferon
      alpha-2a.

      In these heavier patients, the sustained response rate was about 10 percentage
      points higher in the peginterferon alpha-2a group, suggesting that larger
      patients treated with peginterferon alpha-2b also should receive the higher dose
      of ribavirin.

      Although the overall results did not support the superiority of standard-dose
      peginterferon alpha-2b, female patients in the standard-dose group had a
      sustained virologic response rate of 44.3% compared with 35.9% in the low-dose
      alpha-2b group.

      The authors found a significant interaction between treatment group and sex
      (P=0.01), suggesting that women may do better with standard-dose peginterferon
      alpha-2b.

      Best wishes,
      http://www.healtyhepper.com
      Objective Review of Complimentary and Alternative Medicine for Hepatitis C
    Your message has been successfully submitted and would be delivered to recipients shortly.