Hepatitis C treatment among racial and ethnic groups in the IDEAL trial
Hepatitis C treatment among racial and ethnic groups in the IDEAL trial
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DOI：
10.1111/j.1365-2893.2010.01402.x
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发表时间：
2011-04-01
影响因子：
2.5
通讯作者：
McCone, J.
中科院分区：
文献类型：
--
作者：
Muir, A. J.;Hu, K. -Q.;McCone, J.
以前对慢性丙型肝炎病毒(丙型肝炎病毒)治疗的研究表明，种族和民族之间的反应存在差异，包括非洲裔美国人和西班牙裔患者的有效率较低。用于评估最佳聚乙二醇化干扰素治疗效果的个体化剂量与统一剂量的对比试验(IDEAL)试验招募了来自118个美国中心的3070名患者，以比较使用聚乙二醇化干扰素(聚乙二醇化干扰素)α-2a和病毒唑(RBV)以及两种剂量的聚乙二醇化干扰素(聚乙二醇化干扰素)α-2b和RBV的治疗效果。这项分析检查了试验中主要种族和民族群体的治疗反应。总体而言，白人患者的持续病毒学应答(SVR)率为44%，非裔美国人为22%，西班牙裔患者为38%，亚裔美国患者为59%。对于治疗4周未检出HCVRNA的患者，SVR对白人、非裔、西班牙裔和亚裔患者的阳性预测值分别为86%、92%、83%和%。在治疗12周时，未检测到HCVRNA的患者SVR的阳性预测值为72%至81%。使用基线特征的多元回归分析表明，治疗方案不是SVR的预测因素。尽管不同种族和民族的SVR率有很大差异，但白人和西班牙裔患者的SVR率相似。在所有组中，治疗反应很大程度上取决于治疗前12周的抗病毒活性。因此，有关丙型肝炎病毒治疗的决定应该考虑早期治疗反应的预测价值，而不仅仅是基线特征，如种族和民族。
Previous studies of chronic hepatitis C virus (HCV) treatment have demonstrated variations in response among racial and ethnic groups including poorer efficacy rates among African American and Hispanic patients. The individualized dosing efficacy vs flat dosing to assess optimaL pegylated interferon therapy (IDEAL) trial enrolled 3070 patients from 118 United States centres to compare treatment with peginterferon (PEG-IFN) alfa-2a and ribavirin (RBV) and two doses of PEG-IFN alfa-2b and RBV. This analysis examines treatment response among the major racial and ethnic groups in the trial. Overall, sustained virologic response (SVR) rates were 44% for white, 22% for African American, 38% for Hispanic and 59% for Asian American patients. For patients with undetectable HCV RNA at treatment week 4, the positive predictive value of SVR was 86% for white, 92% for African American, 83% for Hispanic and 89% for Asian American patients. The positive predictive values of SVR in those with undetectable HCV RNA at treatment week 12 ranged from 72% to 81%. Multivariate regression analysis using baseline characteristics demonstrated that treatment regimen was not a predictor of SVR. Despite wide-ranging SVR rates among the different racial and ethnic groups, white and Hispanic patients had similar SVR rates. In all groups, treatment response was largely determined by antiviral activity in the first 12 weeks of treatment. Therefore, decisions regarding HCV treatment should consider the predictive value of the early on-treatment response, not just baseline characteristics, such as race and ethnicity.