Comment on a systematic review of randomized trials of peginterferon alpha-2a versus peginterferon alpha-2b in chronic hepatitis C

Authors

  • Ashwani K. Singal M.D.,

    1. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
    2. Division of Gastroenterology University of Texas Medical Branch, Galveston, TX
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  • Sarat C. Jampana M.D.,

    1. Division of Gastroenterology University of Texas Medical Branch, Galveston, TX
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  • Bhupinderjit S. Anand M.D., Ph.D.

    1. Department of Gastroenterology and Hepatology Michael E. DeBakey Veterans Affairs Medical Center Baylor College of Medicine, Houston, TX
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  • Potential conflict of interest: Nothing to report.

Comment on a Systematic Review of Randomized Trials of Peginterferon Alpha-2a Versus Peginterferon Alpha-2b in Chronic Hepatitis C

To the Editor:

We read with interest the letter by Kershenobich et al. in Hepatology regarding the meta-analysis of randomized trials comparing pegylated interferon (PEG-IFN) alpha-2a and alpha-2b in the treatment of chronic hepatitis C (CHC) by Awad et al.1, 2 We agree regarding the importance of a uniform study population in treatment-naïve patients with CHC. This is especially true for the study by Laguno et al., which included patients coinfected with human immunodeficiency virus (HIV).3

We performed a meta-analysis of four available studies comparing PEG-IFN alpha-2a and peginterferon alpha-2b in the treatment of patients with CHC who have concomitant HIV coinfection: one randomized,3 one prospective–retrospective,4 and two prospective studies5, 6 with one of them reported as an abstract.6 A total of 1009 patients (581 treated with PEG-IFN alpha-2a; sample size, 63-557; mean age, 41 years; 69%-75% males) were treated in the four studies.3-6

Pooled analysis of the data showed that the odds of achieving rapid virologic response (RVR), early virologic response (EVR), and sustained virologic response (SVR) were similar with PEG-IFN alpha-2a and PEG-IFN alpha-2b (Table 1). Similarly, the odds of treatment discontinuation due to serious adverse effects were similar with PEG-IFN alpha-2a and PEG-IFN alpha-2b (Table 1). The data were homogeneous for all the analyses. There was no evidence to indicate any publication bias. After excluding the study reported as an abstract, the results with the two PEG-IFN compounds were still similar.

Table 1. Pooled Analysis of Studies Comparing PEG-IFN Alfa-2a and Alfa-2b for Efficacy in Achieving Different Efficacy Outcomes and Safety
 Number of StudiesNumber of Patients (PEG-IFN Alfa-2a Treated)Odds Ratio95% Confidence IntervalP Value
  1. ETR, end of treatment response; EVR, early virologic response; RVR, rapid virologic response; SAE, serious adverse effects; SVR, sustained virologic response.

RVR2381 (231)1.340.86-2.070.19
EVR2369 (231)1.190.72-1.970.50
SVR2731 (408)1.090.80-1.480.57
Treatment discontinuation due to SAE3802 (443)1.090.73-1.630.68

The SVR rates were 36% and 35% with PEG-IFN alpha-2a and PEG-IFN alpha-2b, respectively. Subgroup analyses of the SVR based on the genotype status (genotype 1 or 4 and genotype 2 or 3) and viral load showed similar efficacy and safety data for the two types of PEG-IFN. The data were homogeneous without any suggestion of publication bias in all the analyses.

In summary, PEG-IFN alpha-2a and PEG-IFN alpha-2b have similar efficacy and safety in the treatment of HCV in HIV-coinfected patients, based on the literature currently available. We agree with Kershenobich et al. that further randomized studies are needed to compare efficacy and safety of the two types of PEG-IFN in the treatment of HCV infection, especially in those individuals coinfected with HIV.

Ashwani K. Singal M.D.*, Sarat C. Jampana M.D.†, Bhupinderjit S. Anand M.D., Ph.D.‡, * Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, † Division of Gastroenterology, University of Texas Medical Branch, Galveston, TX, ‡ Department of Gastroenterology and Hepatology, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX.

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