We appreciate Dahari and Cotler's interest in our findings. We agree that viral kinetics during the lead-in phase with peg-interferon-α/ribavirin (PEG/RBV) may enable individualization and prediction of a minimum therapy duration to effect a sustained virological response (SVR); we likewise agree that further studies would be necessary to confirm this approach.
We believe that Wang, Pfeiffer, and Morgan missed the point of our analysis regarding the interleukin (IL)−28B genotype. We do not dispute that relative to the non-CC subtype, CC conferred an advantage in terms of higher SVR rates (CC 97% and 97% versus non-CC 78% and 76% in double and triple therapy arms, respectively); however, in genotype 1-infected patients with low viral load at baseline who achieve aviremia at week 4 with PEG/RBV, there was no benefit in adding boceprevir, regardless of a patient's IL28B subtype. Although patients with the unfavorable subtype respond less well to therapy, for those patients with low viral load and RVR after lead-in with PEG/RBV there is still no advantage of adding a protease inhibitor.
Brian L. Pearlman, M.D.1Carole M. Ehleben, Ph.D.2
1Center for Hepatitis C, Atlanta Medical Center Medical College of Georgia Emory School of Medicine Atlanta, GA
2Department of Graduate Medical Education Atlanta Medical Center Atlanta, GA