Revisiting the Stopping Rule for Hepatitis C Genotype 1 Patients Treated with Peginterferon Plus Ribavirin
Journal
PLoS ONE
Journal Volume
7
Journal Issue
12
Pages
e52048
Date Issued
2012
Author(s)
Yu M.-L.
Huang C.-F.
Huang J.-F.
Dai C.-Y.
Lin Z.-Y.
Chen S.-C.
Wang L.-Y.
Juo S.-H.H.
Chuang W.-L.
Abstract
Background: The current stopping rule for peginterferon/ribavirin therapy in hepatitis C virus genotype-1 (HCV-1) patients is based on an early virological response (EVR, defined as >2 log10 viral reduction at treatment week 12). We aimed to explore rapid stopping rules at week 4. Methods: We randomly allocated 528 HCV-1 patients into training and validation sets (at a 1:2 ratio). The interleukin-28B rs8099917 genotypes and on-treatment virological responses were evaluated to determine the negative predictive value (NPV) for achieving a sustained virological response (SVR, defined as undetectable HCV RNA 24 weeks after end-of-treatment). The study was approved by the ethics committees of the participating hospitals. All of the patients gave written informed consent before enrollment. Results: A poor week 4 response (W4R), defined as a HCV RNA reduction of <1 log10 IU/mL at week 4 or a week 4 HCV RNA>10,000 IU/mL with interleukin-28B non-TT genotype, had the highest NPV (95%). In the complete sample, poor W4R could identify 43.4% (59/136) of the non-responders, with an NPV of 95% and a false negative rate of only 0.8% (3/396). The multivariate analysis revealed that a poor W4R was the most important negative predictor (odds ratio/95% confidence intervals: 49.01/13.70-175.37), followed by the lack of an EVR. In addition to HCV RNA<1 log10 IU/mL reduction, using the criteria of HCV RNA>10,000 IU/mL/non-TT genotype helped identifying an additional one-third of non-SVR patients at W4.Using the strategy of sequential rapid stopping rule strategy could identify 53.7% (73/136) of the non-responders (43.4% at week 4 and an addition 11.3% at week 12), as compared to 40.4% for the classical week-12 early stopping rule. Conclusions: Sequential rapid stopping rules using on-treatment virological responses and interleukin-28B genotype can rapidly identify additional peginterferon/ribavirin non-responders. ? 2012 Yu et al.
SDGs
Other Subjects
interleukin 28B; peginterferon alpha2a; peginterferon alpha2b; ribavirin; virus RNA; adult; age distribution; article; body weight; controlled study; drug response; drug treatment failure; drug withdrawal; early virological response; end of treatment virological response; false negative result; female; gender; genotype; hepatitis C; homozygote; human; major clinical study; male; poor week 4 response; predictive value; rapid virological response; stopping rule; sustained virological response; treatment duration; validation process; virus load; Adult; Female; Genotype; Hepacivirus; Hepatitis C; Humans; Interferon-alpha; Interleukins; Male; Middle Aged; Polyethylene Glycols; Recombinant Proteins; Ribavirin; Time Factors; Treatment Outcome; Viral Load; Hepatitis C virus; Hepatitis C virus genotype 1; Nucleopolyhedrovirus
Type
journal article