icon-folder.gif   Conference Reports for NATAP  
 
  DDW
Digestive Disease Week
Los Angeles
May 21-24, 2006
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Differences In Treatment Outcome To Antiviral Therapy Based On Genotype And Viral Load In Hepatitis C Genotypes 2 And 3 In The WIN-R Trial
 
 
  Reported by Jules Levin
DDW, May 2006, Los Angeles
 
R.S. Brown, Jr., I.M. Jacobson, N. Afdhal, B. Freilich, M.P. Pauley, F. Regenstein, S. Flamm, P. Kwo, L. Griffel, C.A. Brass, & the WIN-R Study Group
 
WIN-R Study: final results of Weight-Based dosing study of ...Here is link to report on WIN-R Study presentation at AASLD Nov 2005 written by Jules Levin www.natap.org/2005/AASLD/aasld_59.htm
 
WIN-R Trial: Background
Weight-Based Interferon and Ribavirin Trial

- Peginterferon (PEG-IFN) alfa-2b 1.5 mg/kg/week + ribavirin (RBV) 800 mg/day was superior to two other regimens using RBV 1000-1200 mg/day in a pivotal trial
- Manns et al, Lancet 2001
- Regression analysis showed a linear relationship between RBV dose in mg/kg and sustained virological response (SVR) supporting the use of weight-based dosing of RBV
- A large prospective trial - WIN-R - comparing RBV doses was designed to address fixed dose RBV 800 mg vs weight-based RBV dosing
 
WIN-R: G 2/3 Analysis
- Patients with G 2/3 chronic hepatitis C have high SVR rates with PEG-IFN alfa and RBV
- Require shorter duration of treatment
- May not need high dose of RBV
- Optimal dosing of RBV and differences between SVR in G 2/3 patients is undefined
 
Objective of analysis
To analyze the efficacy of PEG-IFN alfa-2b plus RBV in patients with HCV G 2/3 in the WIN-R trial
 
WIN-R Trial
- US multicenter, randomized, open-label, investigator-initiated trial between 12/2000 and 6/2005
- Randomized treatment-naive adults stratified by genotype (1 and non-1) and fibrosis
- 25 regional investigators, 225 sites
- Nearly 5000 patients; 1829 patients with G 2/3
- Central lab (SPRI) for quantitative PCR for HCV RNA
- Lower limit of detection was 29 IU/ml
- 0, 24, 48, 72 weeks
 

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Study Populations and Analyses
- Intent-to-treat (ITT) population
- All subjects who received at least one dose of study drug
- Used for safety analysis
- Primary efficacy population
- All subjects who received at least one dose of study drug and weighed ≥65 kg
- Used for primary efficacy end point - SVR
- Completers analysis population
- All subjects who received at least one dose of study drug, completed the study, and had end-of-treatment data available
 
Study Enrollment and Randomization:
HCV G 2/3 Subjects

 

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WIN-R: Genotype 2/3 Conclusions
- 24 weeks of PEG-IFN alfa-2b + RBV was sufficient for HCV G 2/3 patients
 
- PEG-IFN alfa-2b + fixed-dose (800 mg) RBV for 24 weeks was sufficient for Genotype 2 patients
 
- Overall, G 2 patients had higher SVR rates from treatment with PEG-IFN alfa-2b + RBV than G 3 patients
 
- Weight-adjusted doses of RBV may benefit patients with G 3 and high viral load
 
- Treatment with PEG-IFN alfa-2b + RBV resulted in consistently low relapse rates in G 2/3 patients treated for either 24 weeks or 48 weeks
 
- No clear differences were seen in SVR and relapse rates for G3 HVL with longer duration of treatment
 
- Further research is needed to define optimal treatment for G3 HVL