Hepatology and Liver Transplantation, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Aliment Pharmacol Ther. 2010 Jun;31(12):1251-67. doi: 10.1111/j.1365-2036.2010.04300.x. Epub 2010 Mar 17.
For patients with chronic hepatitis C, attaining rapid virological response (RVR) is highly predictive of attaining SVR.
To consider the predictive value of RVR in terms of SVR and relapse.
Data were collected from published clinical trials to define the predictive value of RVR for SVR and evaluate the proposed continuum linking RVR to relapse.
These data support a 24-week regimen among genotype (G)1 patients who attain RVR with positive predictive values (PPVs) of 77.8% and 85.7% in patients with G1 infection treated for 24 and 48 weeks. Conversely, failure to attain RVR among G1 patients should not be viewed as a criterion for extending treatment duration beyond 48 weeks: negative predictive values (NPVs) were 60.9% and 52.7% in G1 patients without RVR treated for 48 and 72 weeks. Among G2/3 patients, RVR has a high PPV; however, the NPV varied with treatment duration indicating that a 24-week treatment regimen is warranted in G2/3 patients who fail to attain RVR.
The present analysis confirms RVR as a strong predictor of SVR that can be used to tailor treatment duration, but which also should be appreciated in the context of treatment duration and regimen.
对于慢性丙型肝炎患者，快速病毒学应答 (RVR) 是获得持续病毒学应答 (SVR) 的高度预测指标。
考虑 RVR 在 SVR 和复发方面的预测价值。
从已发表的临床试验中收集数据，以确定 RVR 对 SVR 的预测价值，并评估将 RVR 与复发联系起来的建议连续体。
这些数据支持在基因型 (G)1 患者中使用 24 周方案，对于接受 24 周和 48 周治疗的 G1 感染患者，获得 RVR 的阳性预测值 (PPV) 分别为 77.8%和 85.7%。相反，对于未能获得 RVR 的 G1 患者，不应将其视为将治疗时间延长至 48 周以上的标准：在未获得 RVR 的 G1 患者中，NPV 分别为 60.9%和 52.7%，治疗时间分别为 48 周和 72 周。在 G2/3 患者中，RVR 具有高 PPV；然而，NPV 随治疗时间而变化，这表明在未能获得 RVR 的 G2/3 患者中，应采用 24 周的治疗方案。
本分析证实 RVR 是 SVR 的强有力预测指标，可用于调整治疗持续时间，但也应在治疗持续时间和方案的背景下加以考虑。
