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HCV Can Be Cured
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Reported by Jules Levin
DDW, May 23, 2007, Wash DC
The very same presentation by Mark Swain at DDW was presented the previous month at the annual European liver conference called EASL.
"Sustained virologic response (SVR) resulting from treatment with peginterferon alfa-2a (40KD) (PEGASYS) alone or in combination with ribavirin (COPEGUS) is durable and constitutes a cure: an ongoing 5-year follow-up"
MG Swain, M-Y Lai, ML Shiffman, WGE Cooksley,
A Abergel, A Lin, E Connell and M Diago
Mark G. Swain MD
University of Calgary, Canada
Selected highlights from Swain's slide talk.
Authors concluded: An SVR achieved with peginterferon alfa-2a (40KD) +/- ribavirin, is durable for up to 5 years after completion of therapy
99.2% of patients who achieved an SVR remained HCV RNA undetectable at
mean 4.1 (0.4-7) years follow-up. The study only followed patients for the average of 5 years. Continued followup should find similar results as smaller studies previously published have followed patients for 10 years finding similar results.
Sustained virological response (SVR) rates of up to 66% have been reported with peginterferon alfa-2a (40KD) (PEGASYS) plus ribavirin (COPEGUS) in HCV mono-infected patients, and 40% in those co-infected with HCV and HIV.
However, although the benefits of viral eradication have been well established, the overall durability of an SVR is less well-known.
Our study objective was to quantify the long-term durability of an SVR achieved with peginterferon alfa-2a (40KD), administered either as monotherapy or as combination therapy with ribavirin.
The study looked at patients who participated in one of nine randomized, multicenter trials involving peginterferon alfa-2a (40KD) +/- ribavirin.
The patients must have achieved an SVR, defined as undetectable HCV RNA (<50 IU/mL) at 24 weeks' follow-up, and received no further treatment.
Patients were annually tested for 5 years for HCV RNA in serum
Using the Roche COBAS AMPLICOR HCV Test v2.0 (limit of detection 50 IU/mL).
PATIENT FOLLOW-UP
997 patients who achieved an SVR are undergoing long-term follow-up
-- 163 mono-infected patients received peginterferon alfa-2a (40KD) monotherapy
-- 741 mono-infected patients received peginterferon alfa-2a (40KD) + ribavirin combination therapy
-- 93 HIV-HCV co-infected patients received peginterferon alfa-2a (40KD) +/- ribavirin
RESULTS
Overall, 99.2% of patients who achieved an SVR remained HCV RNA undetectable at a mean of 4.1 (0.4-7) years follow-up
8 patients (0.8%) who achieved an SVR became HCV RNA-positive a mean
2 (1.1-2.9) years after completing therapy.
It is currently unclear whether patients who became HCV RNA detectable during follow-up experienced re-infection, rather than virological relapse.
Patients with a durable SVR at a mean of 4.1 years (0.4 to 7) years of follow-up.
99.2% for all (997).
98.8% for monotherapy.
99.2% for combination therapy.
100% for combination therapy, 'normal ALT.
98.9% for mono- or combination therapy for HCv/HIV coinfected.
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