Re-treatment with peginterferon alfa-2a and ribavirin in patients with chronic hepatitis C who have relapsed or not responded to a first course of pegylated interferon-based therapy.
Re-treatment with peginterferon alfa-2a and ribavirin in patients with chronic hepatitis C who have relapsed or not responded to a first course of pegylated interferon-based therapy.
复制标题
对第一个疗程的聚乙二醇化干扰素治疗复发或无反应的慢性丙型肝炎患者使用聚乙二醇干扰素 α-2a 和利巴韦林重新治疗。
DOI：
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发表时间：
2009
期刊：
影响因子：
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通讯作者：
K. Peltekian
中科院分区：
文献类型：
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作者：
E. Yoshida;M. Sherman;V. Bain;C. Cooper;M. Deschênes;P. Marotta;Samuel S. Lee;M. Krajden;H. Witt‐Sullivan;R. Bailey;Christopher Usaty;K. Peltekian
背景
聚乙二醇干扰素（pegIFN）和利巴韦林联合治疗仍然是慢性丙型肝炎病毒（HCV）感染的一线治疗。与在初治患者中进行的大量研究相反，在既往基于聚乙二醇干扰素的治疗失败的患者中重新治疗的有效性在很大程度上未报告。
目的
评估既往以pegIFN α-2a和利巴韦林为基础的初始疗程治疗失败的患者再次治疗的有效性。
方法
对一项多中心开放标签研究进行了事后分析。患者接受聚乙二醇干扰素α-2a和利巴韦林，剂量为800 mg/天，随后为1000 mg/天至1200 mg/天，持续24至48周，由研究者决定。分析第12周（早期病毒学应答[EVR]）和第24周（持续病毒学应答[SVR]）的结局。
结果
分析了87例既往基于pegIFN的治疗后复发的患者（n=28; 78%基因型1）或无应答者（n=59; 71%基因型1）。在复发者中，86%实现了EVR，68%实现了SVR。在pegIFN单药治疗（n=15）或pegIFN加利巴韦林（n=13）的复发者中，分别有60%和77%达到了SVR。纤维化和基因型并不影响复发者SVR的可能性，尽管这可能是患者数量相对较少的结果。在既往无应答者中，53%实现了EVR，但仅17%发生了SVR。在pegIFN单药治疗（n=9）和pegIFN加利巴韦林（n=50）的无应答者中，分别有33%和14%达到了SVR。基因型不影响无应答者的SVR。肝活检METAVIR评分为F3或F4的仅10%达到SVR。
结论
既往基于聚乙二醇干扰素的治疗后复发与治疗成功的可能性很高相关，而既往无应答患者的再治疗则无相关性。
BACKGROUND
Pegylated interferon (pegIFN) and ribavirin combination therapy remains the first-line treatment for chronic hepatitis C virus (HCV) infection. In contrast to the wealth of studies in treatment-naive patients, the effectiveness of retreatment in patients who have previously failed pegIFN-based therapy is largely unreported.
AIM
To assess the effectiveness of the retreatment of patients who have previously failed an initial course of pegIFN-based therapy with pegIFNalpha-2a and ribavirin.
METHODS
A post-hoc analysis of a multicentre open-label study was performed. Patients received pegIFNalpha-2a and ribavirin at a dose of 800 mg/day and later 1000 mg/day to 1200 mg/day for 24 to 48 weeks at the discretion of the investigator. Outcomes at week 12 (early virological response [EVR]) and week 24 (sustained virological response [SVR]) were analyzed.
RESULTS
Eighty-seven patients who had relapsed after previous pegIFN-based therapy (n=28; 78% genotype 1) or were nonresponders (n=59; 71% genotype 1) were analyzed. Of the relapsers, 86% achieved an EVR and 68% achieved an SVR. In relapsers to pegIFN monotherapy (n=15) or pegIFN plus ribavirin (n=13), 60% and 77% achieved an SVR, respectively. Fibrosis and genotype did not affect the likelihood of SVR in relapsers although this may be the result of the relatively small number of patients. In previous nonresponders, an EVR was achieved in 53% but an SVR occurred in only 17%. In nonresponders to pegIFN monotherapy (n=9) and pegIFN plus ribavirin (n=50), 33% and 14% achieved an SVR, respectively. Genotype did not affect SVR in nonresponders. Only 10% with a METAVIR score of F3 or F4 on liver biopsy achieved an SVR.
CONCLUSIONS
Relapse after previous pegIFN-based therapy is associated with a strong probability of treatment success whereas retreatment of those with previous nonresponse does not.