Shortening of treatment duration in patients with chronic hepatitis C genotype 2 and 3 - impact of ribavirin dose - a randomized multicentre trial
1 Gastroenterology & Hepatology, Elisabethinen Hospital, Fadingerstrasse 1, Linz, 4020, Austria
2 Hygiene, Microbiology and Tropical Medicine, Elisabethinen Hospital, Fadingerstrasse 1, Linz, 4020, Austria
3 Gastroenterology & Hepatology, Internal Medicine III, Medical University Vienna, Waehringergürtel 18 - 20, Vienna, 1090, Austria
4 Internal Medicine 4, Sozialmedizinisches Zentrum Süd - Kaiser-Franz-Josef Hospital, Kundratstraße 3, Wien 1100, Austria
5 Department of Psychiatry and Psychotherapy, Medical University Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
6 Internal Medicine 4, Hospital Rudolfstiftung, Juchgasse 25, Vienna, 1030, Austria
7 Internal Medicine 4, Wilhelminenhospital, Montleartstraße 37, Vienna, 1160, Austria
BMC Research Notes 2011, 4:220 doi:10.1186/1756-0500-4-220Published: 29 June 2011
Chronic hepatitis C (CHC) Patients, infected with genotype (GT) 2 or 3 are treated with Peg-IFN and ribavirin (RBV) (800 mg/day) for 24 weeks. Treatment duration can be shortened to 12-16 weeks if a higher dose of RBV (1.000/1.200 mg/day) was used without considerable loss of responsiveness or increased risk of relapse. Previously we have shown that in patients with CHC, GT 2/3 RBV can be reduced to 400 mg/day if administered for 24 weeks without an increase in relapse rates. Therefore we investigated the efficacy of a reduced RBV dosage of 400 mg/day with shorter treatment duration (16 weeks).
Treatment naïve patients with CHC, GT 2/3 were randomized to receive 180 μg peginterferonα2a/week in combination with either 800 (group C) or 400 mg/d (group D) for 16 weeks. The primary endpoint was SVR.
12 months after the first patient was randomized a inferior outcome of group D as compared to group C was noted, therefore the study was terminated. At study termination 89 patients were enrolled (group C: 31, D: 51). The SVR rate was statistically different in the two study groups with 51.6% in group C and 28.4% in group D (p = 0.038). Patients with low viral load had higher SVR rates (C: 67%, D: 33%) than those with high viral load (C: 33%, D: 21%).
Both treatment duration and the dose of RBV play a major role to optimize outcome of patients with GT3. If one intends to shorten the treatment weight based RBV dose should be used, if lower RBV doses are used patients should be treated for at least 24 weeks as. A treatment regimen with a reduced RBV dosage and shortened treatment duration is associated with low SVR rates due to high relapse rates.