Center for HIV and Hepatogastroenterology, Düsseldorf, Germany.
J Viral Hepat. 2011 Apr;18(4):e81-90. doi: 10.1111/j.1365-2893.2010.01372.x. Epub 2010 Sep 16.
The likelihood of a sustained virological response (SVR) is the most important factor for physicians and patients in the decision to initiate and continue therapy for chronic hepatitis C (CHC) infection. This study identified predictive factors for SVR with peginterferon plus ribavirin (RBV) in patients with CHC treated under 'real-life' conditions. The study cohort consisted of patients from a large, retrospective German multicentre, observational study who had been treated with peginterferon alfa-2a plus RBV or peginterferon alfa-2b plus RBV between the years 2000 and 2007. To ensure comparability regarding peginterferon therapies, patients were analysed in pairs matched by several baseline variables. Univariate and multivariate logistic regression analyses were used to determine the effect of nonmatched baseline variables and treatment modality on SVR. Among 2378 patients (1189 matched pairs), SVR rates were 57.9% overall, 46.5% in HCV genotype 1/4-infected patients and 77.3% in genotype 2/3-infected patients. In multivariate logistic regression analysis, positive predictors of SVR were HCV genotype 2 infection, HCV genotype 3 infection, low baseline viral load and treatment with peginterferon alfa-2a. Negative predictors of SVR were higher age (≥40 years), elevated baseline gamma-glutamyl transpeptidase (GGT) and low baseline platelet count (<150,000/μL). Among patients treated with peginterferon plus RBV in routine clinical practice, genotype, baseline viral load, age, GGT level and platelet levels all predict the likelihood of treatment success. In patients matched by baseline characteristics, treatment with peginterferon alfa-2a may be a positive predictor of SVR when compared to peginterferon alfa-2b.
持续病毒学应答 (SVR) 的可能性是医生和患者在决定启动和继续慢性丙型肝炎 (CHC) 感染治疗时最重要的因素。本研究确定了在“真实生活”条件下接受聚乙二醇干扰素加利巴韦林 (RBV) 治疗的 CHC 患者获得 SVR 的预测因素。该研究队列由来自德国一项大型回顾性多中心观察性研究的患者组成，这些患者在 2000 年至 2007 年期间接受了聚乙二醇干扰素 alfa-2a 加 RBV 或聚乙二醇干扰素 alfa-2b 加 RBV 治疗。为了确保聚乙二醇干扰素治疗的可比性，根据几个基线变量对患者进行配对分析。使用单变量和多变量逻辑回归分析来确定非匹配基线变量和治疗方式对 SVR 的影响。在 2378 例患者（1189 对匹配患者）中，SVR 率总体为 57.9%，HCV 基因型 1/4 感染患者为 46.5%，基因型 2/3 感染患者为 77.3%。在多变量逻辑回归分析中，SVR 的阳性预测因素是 HCV 基因型 2 感染、HCV 基因型 3 感染、低基线病毒载量和聚乙二醇干扰素 alfa-2a 治疗。SVR 的阴性预测因素是年龄较高（≥40 岁）、基线 γ-谷氨酰转肽酶 (GGT) 升高和基线血小板计数较低（<150,000/μL）。在常规临床实践中接受聚乙二醇干扰素加 RBV 治疗的患者中，基因型、基线病毒载量、年龄、GGT 水平和血小板水平均预测治疗成功的可能性。在匹配基线特征的患者中，与聚乙二醇干扰素 alfa-2b 相比，聚乙二醇干扰素 alfa-2a 治疗可能是 SVR 的阳性预测因素。
