Department of Gastroenterology and Endocrinology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075 Göttingen, Germany.
Dig Dis Sci. 2011 Nov;56(11):3296-304. doi: 10.1007/s10620-011-1933-2. Epub 2011 Oct 13.
The standard treatment regimen for chronic HCV genotype 3 (HCV-G3) hepatitis consists of PEGylated interferon-α (IFN-α) and ribavirin at varying doses ranging from 400 to 1,200 mg and results in response rates of 80%. However, this therapy has substantial side-effects including anemia, is teratogenic, and costly. To reduce the side-effects of therapy, the role of monotherapy consisting of only IFN-α was investigated.
A retrospective analysis of individual therapy courses of HCV-G3-infected patients who were treated with IFN-α(2a) monotherapy or a combination therapy with attention to the treatment outcome and the presence of IL28B rs12979860 and IL28B rs8099917 single-nucleotide polymorphism genotypes was performed. Conventional prognostic features in each case were assessed as well.
In the study, 15/30 (50%) of patients treated with IFN-α(2a) monotherapy and 32/36 (89%) treated with combination therapy achieved a sustained virological response (SVR). In addition, 7/11 (64%) of those treated initially with monotherapy and subsequently with combination therapy achieved an SVR. An "ultra-rapid" virological response occurring within 2 weeks of initiation of therapy (p = 0.005), young age (<40; p < 0.001) and low initial γ-GT/ALT-ratio (p = 0.03) were associated with a SVR to IFN-α(2a) monotherapy. An SVR in those treated with combination therapy was found to be associated with a rapid virological response (RVR) (p = 0.03). The absence of histologic steatosis was associated with SVR in all patient groups (p = 0.01). Therapy duration (24 vs. 48 weeks) did not affect the SVR in either group. As expected, combination therapy resulted in more hematological side-effects than did monotherapy.
An "ultra-rapid" virological response, young age, low initial γ-GT/ALT-ratio and absence of steatosis were each associated with an SVR in those receiving IFN-α(2a) monotherapy. Therefore, monotherapy in these patients should still be discussed independently of the existence of the IL28B polymorphisms.
慢性丙型肝炎基因型 3（HCV-G3）的标准治疗方案包括聚乙二醇干扰素-α（IFN-α）和利巴韦林，剂量范围为 400 至 1200mg，应答率为 80%。然而，这种治疗方法有很多副作用，包括贫血、致畸和昂贵。为了降低治疗的副作用，研究了仅用 IFN-α组成的单药治疗的作用。
对接受 IFN-α（2a）单药治疗或联合治疗的 HCV-G3 感染患者的个别治疗疗程进行回顾性分析，重点关注治疗结果和 IL28B rs12979860 和 IL28B rs8099917 单核苷酸多态性基因型的存在。在每种情况下还评估了常规预后特征。
在研究中，15/30（50%）接受 IFN-α（2a）单药治疗的患者和 32/36（89%）接受联合治疗的患者获得持续病毒学应答（SVR）。此外，7/11（64%）最初接受单药治疗随后接受联合治疗的患者获得 SVR。治疗开始后 2 周内发生的“超快”病毒学应答（p=0.005）、年龄较轻（<40；p<0.001）和初始γ-GT/ALT 比值较低（p=0.03）与 IFN-α（2a）单药治疗的 SVR 相关。联合治疗组的 SVR 与快速病毒学应答（RVR）相关（p=0.03）。所有患者组中无组织学脂肪变性与 SVR 相关（p=0.01）。治疗持续时间（24 周与 48 周）在两组中均未影响 SVR。正如预期的那样，联合治疗比单药治疗导致更多的血液学副作用。
“超快”病毒学应答、年轻、初始γ-GT/ALT 比值低和无脂肪变性与接受 IFN-α（2a）单药治疗的患者的 SVR 相关。因此，在这些患者中，无论是否存在 IL28B 多态性，都应单独讨论单药治疗。
