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Age and Gender
The chances of treatment being successful are best at a younger age and if the patient is female.1,2 Older and male patients are more prone to a poorer response to treatment.
Data from a recent study illustrates the lower SVR rates achieved by older patients: the overal SVR rate in patients ≤50 years was 52% compared with 39% in those who were >50 years old (Reddy KR, et al, . 58th AASLD 2007, Abstract # 321). However, further analysis revealed that certain sub-groups of older patients also achieved high SVR rates. For example, SVR rates were higher in patients without advanced fibrosis, those with low baseline serum HCV RNA levels, those who received ≥80% of the planned dose of PEGASYS® and those who received ≥60% of the planned dose of ribavirin. When cumulative exposure to study drug was assessed, a trend towards lower cumulative PEGASYS® exposure and a significantly lower cumulative ribavirin exposure was found in older patients, which may account for their overall lower SVR rates (Reddy KR, et al, . 58th AASLD 2007, Abstract # 321; ReddyKR, et al. Clin Gastro Hepatol 2007). Thus SVR rates in certain subgroups of older patients can be comparable to those of younger patients, providing a high drug adherence is maintained (Reddy KR, et al, . 58th AASLD 2007, Abstract #321).
The HCV Genotype
People with the genotype 2 or 3 strain of HCV are nearly twice as likely to respond to treatment than those with the genotype 1 strain.3 In all genotypes, patients with a low viral load and a rapid virological response (RVR) may be able to shorten their treatment duration: in genotypes 1 and 4 from 48 weeks to 24 weeks, and in genotypes 2/3 from 24 to 16 weeks.
Patients with ‘Normal’ ALT
Alanine aminotransferase (ALT) is an enzyme found primarily in the liver; it is released into the blood stream as a result of liver inflammation. The presence of elevated levels of ALT in people with chronic HCV infection has historically been used as a signal regarding the need for treatment.
While the majority of patients with chronic HCV have elevated levels of ALT, approximately 30 per cent of chronic hepatitis C patients do not.4 It was previously believed that these people only had ‘mild’ liver disease and did not need treatment. However, a growing body of scientific research has revealed that approximately 80 per cent of people with ‘normal’ ALT levels have some level of liver damage and up to 25 per cent have seriously damaged livers5 PEGASYS® is approved for the treatment of patients with 'Normal' ALT.
References:
1. Fried MW, Shiffman ML, Reddy KR, et al. Peginterferon alfa-2a plus ribavirn for chronic hepatitis C virus infection. N Engl J Med 2002; 347(13):975-82.
2. Manns MP, McHutchison JG, Gordon SC, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001;358(9286):958-65.
3. Hadziyannis SJ, Sette H, Jr., Morgan TR, et al. Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med 2004;140(5):346-55.
4. Conry-Cantilena C. et al. Routes of infection, viremia, and liver disease in blood donors found to have hepatitis C virus infection. N Engl J Med. 1996;334(26):1691-6.
5. Puoti C, Castellacci R, Montagnese F, et al. Histological and virological features and follow-up of hepatitis C virus carriers with normal aminotransferase levels: the Italian prospective study of the asymptomatic C carriers (ISACC). J Hepatol 2002;37(1):117-23.