Both authors contributed equally to this work.
Pegylated interferon α-2a plus ribavirin for decompensated hepatitis C virus-related cirrhosis: relationship between efficacy and cumulative dose
Article first published online: 12 DEC 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Volume 34, Issue 10, pages 1522–1531, November 2014
How to Cite
Liver Int. 2014; 34: 1522–1531
- Issue published online: 13 OCT 2014
- Article first published online: 12 DEC 2013
- Accepted manuscript online: 25 NOV 2013 11:27AM EST
- Manuscript Accepted: 16 NOV 2013
- Manuscript Received: 22 JAN 2013
- National Natural Science Foundation of China. Grant Number: 30970415
- cumulative dose;
- decompensated cirrhosis;
- hepatitis C virus;
- virological response
Background & Aims
A combination of pegylated interferon alpha-2a (Peg-IFNα-2a) and ribavirin (RBV) achieves a sustained virological response (SVR) in 40–50% of patients infected with genotype 1 hepatitis C virus (HCV), but efficacy rates are significantly lower in patients with decompensated HCV-induced cirrhosis. The efficacy and tolerability of Peg-IFNα-2a and RBV, the cumulative dose effect, time to achieve planned cumulative dose and role of HCV phenotype on treatment response were determined in patients with decompensated HCV-induced cirrhosis.
In this case-controlled study, 257 patients with decompensated HCV-induced cirrhosis were enrolled, including patients treated with partial splenic embolization for leukopaenia. Of patients with sufficient blood cell counts, 130 patients opted for antiviral therapy (treatment group) consisting of 180 μg/kg Peg-IFNα-2a for 48 weeks with 800–1200 mg/day RBV; the remaining 127 were considered the control group. Primary endpoints were SVR and absence of relapse; the secondary end point was assessment of disease progression.
Sustained virological response was highest and relapse rates were lowest when cumulative doses of Peg-IFNα-2a and RBV were both ≥80% of the prescribed dose. Patients achieving ≥80% of the planned cumulative doses in 48 weeks had a significantly higher SVR compared with patients achieving this in 72 weeks. Patients with HCV genotype 1 had significantly lower SVR compared with patients with HCV genotype 2 (19.7% vs. 42.9%, respectively; P = 0.008). Treatment group patients had a significantly lower rate of SVR-independent liver disease-related mortality.
Our findings provide additional evidence to support the use of Peg-IFNα-2a and RBV therapy for decompensated HCV-induced cirrhosis.