Efficacy of pegylated interferon and ribavirin for the treatment of chronic hepatitis C, genotype 3 patients in Thailand

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Objective: Direct-acting antivirals [DAAs] arecurrently widely used for treatment of patients with chronic hepatitis C [CHC], Few patients are able to access these regimens, especiallyin developing countries. Pegylated interferon [peg-IFN] and ribavirin [RBV] treatment is, therefore, still important. Since 2012, the Thai government has declared peg-IFN and RBV treatment is the standard of care for Thai patients with CHC. The aims of this study were to evaluate the effectiveness of peg-IFN and RBV treatment in CHC, genotype 3 patients in a real-world setting and to determine factors indicating favorable response. Materials and Methods: This was a retrospective chart review. The data were collected from 30 hospitals in Bangkok and 14 hospitals in Northeastern Thailand during 2012 to 2014. The inclusion criteria were age 18 to 65 years, baseline hepatitis C virus [HCV] viral load [VL] >5,000 IU/mL, naive to treatment, and at least moderate fibrosis before treatment. Patients with HIV or hepatitis B virus [HBV] co-infection or decompensated cirrhosis were excluded. All patients were treated with peg- IFN and RBV for 24 weeks. Results: A total of 523 patients were enrolled. The mean age was 48.7±8.6 years, and 51.6% of patients had age above 50 years. Fifty-two percent were male, and the mean body mass index [BMI] was 24.5±3.7 kg/m 2 . Fifty-eight percent of patients had cirrhosis at baseline. Mean HCV VL was 5.8±0.8 log 10 IU/mL, and 62.1% had HCV VL above 5.6 log 10 IU/mL. The mean alanine aminotransferase [ALT] level at baseline was 106.8±66.5 U/L, and the mean platelet count was 158,000±65,900/mm 3 . The overall prevalence of sustained virological response [SVR] was 74.6%. The prevalences of SVR in patients with cirrhosis and without cirrhosis were 66.8% and 84%, respectively (p<0.001). Factors determining good response were noncirrhosis, HCV VL <5.6 log 10 IU/mL at baseline, age <50 years, no reduced dose of peg-IFN during treatment, and platelet count >150,000/mm 3 . Multivariate analysis, however, demonstrated that factors indicating favorable response were age <50 years, no cirrhosis, and HCV <5.6 log 10 IU/mL at baseline. Conclusion: The effectiveness of peg-IFN and RBV for treatment of patients with CHC, genotype 3 was good. Patients with old age, cirrhosis, and high HCV VL at baselinetended to have treatment failure. DAAsmay be considered as the first treatment for patients with these factors.