Davis Gary L, Wong John B, McHutchison John G, Manns Michael P, Harvey Joann, Albrecht Janice
Division of Hepatology, Baylor University Medical Center, Dallas, TX 75246, USA.
Hepatology. 2003 Sep;38(3):645-52. doi: 10.1053/jhep.2003.50364.
Interferon-based regimens for the treatment of chronic hepatitis C have become increasingly effective and are able to eradicate virus in more than one half of cases. Early identification of patients who will not respond is desirable because treatment might be stopped, thereby avoiding the expense and inconvenience of unnecessary therapy. We examined the accuracy of different degrees of viral inhibition during the early weeks of treatment (early virologic response [EVR]) with pegylated interferon alfa-2b and ribavirin (PEG/R) in identifying patients who would not respond to therapy. The best definition of EVR was a reduction in hepatitis C virus (HCV) RNA by at least 2 logs after the first 12 weeks of treatment compared with baseline. Between 69% and 76% of patients achieved this threshold, depending on the treatment regimen, and sustained virologic response (SVR) occurred in 67% to 80% of these patients. Patients who did not reach EVR did not respond to further therapy. If treatment had been stopped in patients without EVR, drug costs would have been reduced by more than 20%. In conclusion, early confirmation of viral reduction following initiation of antiviral therapy for chronic hepatitis C is worthwhile. It provides a goal to motivate adherence during the first months of therapy and a milepost at which to reassess the need for continued treatment. Most patients who are able to complete the first 12 weeks of therapy achieve EVR and have a high probability of SVR. Patients who fail to achieve EVR will not clear virus even if an additional 9 months of therapy is received. Therapy can be confidently discontinued in those cases.
基于干扰素的慢性丙型肝炎治疗方案已变得越来越有效，能够在一半以上的病例中根除病毒。尽早识别出无反应的患者是可取的，因为这样可以停止治疗，从而避免不必要治疗的费用和不便。我们研究了聚乙二醇化干扰素α-2b和利巴韦林（PEG/R）治疗最初几周内不同程度的病毒抑制（早期病毒学应答 [EVR]）在识别无治疗反应患者方面的准确性。EVR的最佳定义是治疗前12周后丙型肝炎病毒（HCV）RNA较基线水平至少降低2个对数。根据治疗方案的不同，69%至76%的患者达到了这一阈值，这些患者中有67%至80%获得了持续病毒学应答（SVR）。未达到EVR的患者对进一步治疗无反应。如果对未达到EVR的患者停止治疗，药物成本将降低超过20%。总之，慢性丙型肝炎抗病毒治疗开始后早期确认病毒载量降低是值得的。它为治疗最初几个月激励患者坚持治疗提供了一个目标，也是重新评估是否需要继续治疗的一个里程碑。大多数能够完成治疗前12周的患者实现了EVR，并有很高的概率获得SVR。未达到EVR的患者即使再接受9个月的治疗也无法清除病毒。在这些情况下可以放心地停止治疗。
