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SVR Durable (99%) After 5 Years of Followup
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Reported by Jules Levin
EASL, April 11-15, 2007
Barcelona, Spain
Mark Swain from Canada looked at the durability of Sustained Viral Responses with Pegasys based therapy. 5 years after achieving SVR 99% of patients maintained undetectable HCV viral load, Swain called these patients cured. Swain reported 5 year followup on 997 treatment-naïve patients who achieved an SVR who received Pegasys monotherapy (3 studies) or Pegasys + ribavirin (6 studies) in one of 9 studies. This included 163 patients who received Pegasys monotherapy, 741 who received Pegasys plus ribavirin combination therapy, and 93 HCV/HIV coinfected patients who received Pegasys with or without ribavirin. Achievement of an SVR was defined as undetectable HCV RNA (50 IU/mL) at 24 weeks after completing treatment. Annual testing was performed for 5 years for HCV RNA in serum with the COBAS AMPLICOR HCV test v2.0 (limit of detection 50 IU/mL). 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. Of note, this high rate of durability was the same regardless of whether patients received monotherapy (98.8%), combination therapy (99.2%), combination therapy with normal ALT (100% n=75), or were coinfected (98.9%). He combined the results of whether you received mono- or combination for the coinfected patients. 8 patients (0.8%) who achieved an SVR became HCV RNA-positive a mean 2 (1.1-2.9) years after completing therapy, and Swain said "it is currently unclear whether patients who became HCV RNA detectable during follow-up experienced re-infection, rather than virological relapse. Regrading the 8 patients with detectable HCV RNA, Swain showed characteristics of these patients and "there appear to be no common risk factors associated with detectability of HCV RNA during follow-up". None of the 8 had cirrhosis; 5 had 48 weeks therapy & 3 had 24 weeks therapy. Several received monotherapy with peg, several received 800 mg RBV and several received 1000/1200 mg RBV. Most of the 8 were Caucasian.
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