Sugawara Kayoko, Koushima Youhei, Inao Mie, Nakayama Nobuaki, Nagoshi Sumiko, Yakabi Koji, Tamano Masaya, Asabe Shinichi, Nishikawa Ko, Harada Youji, Sekine Chuichi, Fukuya Yuji, Funyu Junji, Hashimoto Yoshiaki, Mochida Satoshi
Department of Gastroenterology and Hepatology, Saitama Medical University Hospital, Saitama Medical University, Saitama.
Department of Gastroenterology, Saitama Red Cross Hospital, Saitama.
Hepatol Res. 2015 Nov;45(11):1091-9. doi: 10.1111/hepr.12475. Epub 2015 Mar 3.
To optimize the therapeutic efficacy of NS3/4A protease inhibitors, a multicenter prospective study was performed according to an algorithm based on the Adherence, IL-28B Gene Allele and Viral Response Trial (AG & RGT).
A total of 340 patients with genotype 1b hepatitis C virus (HCV) showing serum RNA levels of >5 log were enrolled. The duration of ribavirin/pegylated interferon (PEG IFN)-α-2b therapy was prolonged to 48 weeks in patients with unfavorable IL28B alleles showing adherence rates of less than 80% for either drug during the first 12 weeks even if RVR had been achieved, and in those in whom cEVR, but not RVR, was achieved; furthermore, to 72 weeks in those showing partial early viral response.
The therapeutic outcomes were assessed in 282 patients, and the therapy was set to complete at 24 weeks in 181 patients (64%) and to prolong to 48 weeks or 72 weeks in 71 patients (25%). The former group showed a SVR rate of 84%, while the latter group showed an SVR rate of 69% with a relapse rate of 7%. The SVR rate was 33% in the 30 patients (11%) in whom the therapy had to be discontinued in less than 12 weeks. Thus, the results of intention-to-treat analysis revealed an overall SVR rate of 75%. Multivariate analysis identified prolongation of the duration of therapy as a significant factor associated with SVR.
Triple therapy yielded a high SVR rate in the AG & RGT trial via attenuation of viral relapse by prolonged ribavirin/PEG IFN-α-2b administration. © 2015 The Japan Society of Hepatology.
