The Markers Predicting Response to Hepatitis C Virus Treatment and Evaluation of Treatment Responses

Abstract

Objectives: Currently pegylated interferon alpha (peg-IFN) and ribavirin treatment is recommended for chronic hepatitis C treatment. The aim of treatment is to provide sustained viral response (SVR). Material and Methods: A total of 125 patients, who have been treated for chronic hepatitis C diagnosis and are followed up until 6 months after treatment, were enrolled into the study. Markers, which have indicated treatment response against hepatitis C virus treatment, treatment responses according to peg-IFN&alpha; type used, and experienced side effects in patients have been compared. Results: Of patients, 103 were (82.4%) female and 22 were (17.6%) male and mean of age was 54.74&plusmn;7.93 years. Markers indicating SVR in our study were calculated as rapid viral response (RVR) (p<0.001); early viral response (EVR) (p<0.001); high baseline thrombocyte (x103 / &micro;l) value (240,93 &plusmn; 75,61) (p<0.004); baseline total bilirubin level (0.55&plusmn;0.19) (p2) (p<0.034). Predictive parameters for EVR in our study were defined as absence of diabetes in patients, high baseline lymphocyte numbers (2024.74&plusmn;625.93) and high baseline cholesterol level (in EVR positive patients 180.47&plusmn;32.77 mg/dl; in EVR negatives 152.00&plusmn;24.56). There was no statistical difference between peg-IFN type in patients and RVR, EVR and SVR. Also there was no statistical difference in hematological side effects (neutropenia, anemia, and thrombocytopenia) in both treatment groups. Conclusions: As the efficacy of treatment against HCV is defined, predictive markers for the treatment response are becoming more significant. Therefore, it is concluded that these factors should also be considered in patient treatment plans.

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The Markers Predicting Response to Hepatitis C Virus Treatment and Evaluation of Treatment Responses

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Kaynakça

1. Lavanchy D. The global burden of hepatitis C. Liver Int 2009; 29:74–81.
2. Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH. Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med 2000; 132:296-305.
3. Simmonds P, Bukh J, Combet C, et al. Consensus proposals for a unified system of nomenclature of hepatitis C virus genotypes. Hepatology 2005; 42:962-973.
4. Antaki N, Craxi A, Kamal S, et al. The neglected hepatitis C virus genotypes 4, 5 and 6: an international consensus report. Liver Int 2010; 30:342-355.
5. Jang JY, Chung RT. Chronic hepatitis C. Gut Liver 2011; 5:117-132.
6. Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009; 49:1335-1374.
7. McHutchison JG, Lawitz EJ, Shiffman ML, et al. Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection. New Engl J Med 2009; 361:580-593.
8. Bacon BR, Gordon SC, Lawitz E, et al. Boceprevir for previously treated chronic HCV genotype 1 infection. N Engl J Med. 2011; 364:1207-1217.

9. Manns MP, McHutchison JG, Gordon SC, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001; 358:958-965.
10. Hadziyannis SJ, Sette HJr, Morgan TR, et al. Peginterferonalpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med 2004;140:346-355.
11. Zeuzem S, Fried MW, Reddy KR, et al. Improving the clinical relevance of pretreatment viral load as a predictor of sustained virological response (SVR) in patients infected with Hepatitis C genotype 1 treated with peginterferon ALFA-2A (40KD) (PEGASYS®) plus ribavirin (COPEGUS®) [abstract]. Hepatology 2006;44(Suppl 1):267.
12. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatitis C virus infection. J Hepatol. 2011;55: 245-264.
13. Ferenci P, Fried MW, Shiffman ML, et al. Predicting sustained virological responses in chronic hepatitis C patients treated with peginterferon alfa-2a (40 KD)/ribavirin. J Hepatol 2005; 43:425-433.
14. Jensen DM, Morgan TR, Marcellin P, et al. Early identification of HCV genotype 1 patients responding to 24 weeks peginterferon alpha-2a (40 kd)/ribavirin therapy. Hepatology 2006; 43:954-960.
15. Hwang EW, Thomas IC, Cheung R, Backus LI. Implications of rapid virological response in hepatitis C therapy in the US veteran population. Aliment Pharmacol Ther. 2011 Nov 7. doi: 10.1111/j.1365-2036.2011.04903.x. [Epub ahead of print])
16. Davis GL, Wong JB, McHutchison JG, et al. Early virologic response to treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C. Hepatology 2003; 38:645-652.
17. Fried MW, Shiffman ML, Reddy KR, et al. Peginterferon alfa2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002; 347:975-982.
18. Huang CF, Yang JF, Huang JF, et al. Early identification of achieving a sustained virological response in chronic hepatitis C patients without a rapid virological response. J Gastroenterol Hepatol. 2010; 25:758-765.
19. Berg T, von Wagner M, Nasser S, et al. Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon-alfa-2a plus ribavirin. Gastroenterology 2006; 130:1086-1097.
20. Sánchez-Tapias JM, Diago M, Escartín P, et al. Peginterferonalfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology 2006; 131:451-460.
21. Rumi MG, Aghemo A, Prati GM, et al. Randomized study of peginterferon-alpha2a plus ribavirin vs peginterferon-alpha2b plus ribavirin in chronic hepatitis C. Gastroenterology 2010; 138:108-115.
22. Ascione A, De Luca M, Tartaglione MT, et al. Peginterferon alfa-2a plus ribavirin is more effective than peginterferon alfa-2b plus ribavirin for treating chronic hepatitis C virus infection. Gastroenterology 2010; 138:116-122.
23. Thompson AJ, Muir AJ, Sulkowski MS, et al. Interleukin28B polymorphism improves viral kinetics and is the strongest pretreatment predictor of sustained virologic response in genotype 1 hepatitis C virus. Gastroenterology 2010; 139:120-129.
24. Tsubota A, Fujise K, Namiki Y, Tada N. Peginterferon and ribavirin treatment for hepatitis C virus infection. World J Gastroenterol 2011: 28; 17:419-432.