对先前治疗的复发是慢性丙型肝炎病毒感染患者再次治疗反应的最重要因素。
Relapse to prior therapy is the most important factor for the retreatment response in patients with chronic hepatitis C virus infection.
作者信息
Sagir Abdurrahman, Heintges Tobias, Akyazi Zübeyde, Oette Mark, Erhardt Andreas, Häussinger Dieter
机构信息
Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Düsseldorf, Germany.
出版信息
Liver Int. 2007 Sep;27(7):954-9. doi: 10.1111/j.1478-3231.2007.01508.x.
BACKGROUND
Treatment options for hepatitis C have developed rapidly in the past decade. The current treatment of choice is a combination of pegylated-interferon-alpha (PEG-IFN-alpha) and ribavirin. With the development of more therapy options, patients who failed in prior therapy hope to clear hepatitis C virus by undergoing a more effective retreatment regime. In this report, we investigated response rates to combination therapy [standard IFN-alpha or PEG-IFN-alpha and ribavirin] in patients who relapsed or failed in prior therapy.
METHODS
Ninety-three patients were included in this retrospective study. All patients failed to previous IFN-alpha monotherapy (n=55) or to a combination of standard IFN-alpha and ribavirin (n=38). Fifty-nine patients were nonresponders and 34 were relapsers. Thirty-five patients were retreated with standard IFN-alpha plus ribavirin and 58 received PEG-IFN-alpha combination therapy.
RESULTS
Sustained virologic response (SVR) was induced in 31% of all patients. The highest SVR rate (58%) was observed in relapsers to standard IFN-alpha combination therapy who were retreated with PEG-IFN-alpha combination therapy. The SVR rate in relapsers to standard IFN-alpha monotherapy who received a standard IFN-alpha combination therapy was 50%. Relapsers responded in a significantly higher proportion to retreatment than nonresponders (56% vs. 17%, P<0.001). Relapse to previous therapy was identified as an independent predictor for therapy response. The lowest SVR rate was observed in nonresponders to standard IFN-alpha combination therapy who were retreated with PEG-IFN-alpha combination therapy (1/26; 4%).
CONCLUSIONS
In relapsers, retreatment with the most effective therapy regime to date a combination of PEG-IFN-alpha and ribavirin, is promising. However, retreatment with PEG-IFN-alpha combination therapy in nonresponders to standard IFN combination therapy is not effective.
背景
在过去十年中，丙型肝炎的治疗选择迅速发展。目前的首选治疗方法是聚乙二醇化干扰素-α（PEG-IFN-α）和利巴韦林联合使用。随着更多治疗方案的出现，先前治疗失败的患者希望通过更有效的再治疗方案清除丙型肝炎病毒。在本报告中，我们调查了先前治疗复发或失败的患者接受联合治疗[标准干扰素-α或PEG-IFN-α与利巴韦林]的反应率。
方法
本回顾性研究纳入了93例患者。所有患者先前接受干扰素-α单药治疗（n=55）或标准干扰素-α与利巴韦林联合治疗（n=38）均失败。59例患者无反应，34例患者复发。35例患者接受标准干扰素-α加利巴韦林再治疗，58例患者接受PEG-IFN-α联合治疗。
结果
所有患者中31%实现了持续病毒学应答（SVR）。在用PEG-IFN-α联合治疗进行再治疗的标准干扰素-α联合治疗复发患者中，观察到最高的SVR率（58%）。接受标准干扰素-α联合治疗的标准干扰素-α单药治疗复发患者的SVR率为50%。复发患者对再治疗的反应比例显著高于无反应患者（56%对17%，P<0.001）。先前治疗的复发被确定为治疗反应的独立预测因素。在用PEG-IFN-α联合治疗进行再治疗的标准干扰素-α联合治疗无反应患者中，观察到最低的SVR率（1/26；4%）。
结论
对于复发患者，采用迄今为止最有效的治疗方案——PEG-IFN-α和利巴韦林联合治疗进行再治疗，前景良好。然而，对标准干扰素联合治疗无反应的患者采用PEG-IFN-α联合治疗进行再治疗无效。
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