Kosin Med J.  2012 Dec;27(2):111-118. 10.7180/kmj.2012.27.2.111.

The Combination Therapy with Peg-interferon Alfa and Ribavirin for Chronic Hepatitis C in Korea as an Initial Treatment

• Park DH
• Lee SU
• Yu JS
• Lee JS
• Kwon HJ

• KMID: 2308519
• DOI: http://doi.org/10.7180/kmj.2012.27.2.111

Abstract

OBJECTIVES
The combination therapy with peginterferon and ribavirin has been used to treat chronic hepatitis C for several years in Korea but there is a few report about the results of the treatment. We evaluated safety and efficacy of the combination therapy with Peg-interferon and ribavirin and analyzed factors that may affect treatment.
METHODS
Total 72 untreated chronic hepatitis C patients were administered pegylated interferon alfa-2a (180microg/week) or alfa-2b (1.5microg/kg/week) and ribavirin (800 mg/day in genotype 2, 1000-1200 mg/day in genotype 1). Duration of the treatment was 24 weeks in genotype 2 and 48 weeks in genotype 1. Response of the treatment was evaluated by rapid virologic response (RVR), early virologic response (EVR), end treatment virologic response (ETR), sustained virologic response (SVR) and adverse event.
RESULTS
The RVR, EVR, ETR, SVR were 61.8%, 82.5%, 88.9% and 80.5% retrospectively. The SVR of genotype 1 was 63.4% and non-genotype 1 was 96.7%. Genotype (Odds ratio: 14.92) was an independent predictor of the SVR. Leukocytopenia, flu-like symptoms, itching, rash and anemia were common adverse events of the combination therapy and if then we reduced dose and there was one case of cessation.
CONCLUSIONS
The combination therapy with Peg-interferon and ribavirin shows efficacy to the Korean patients with chronic hepatitis C as an initial treatment. Genotypes 2 and 3 were more likely to have a sustained virologic response.

Keyword

Hepatitis C; Peginterferon alfa-2a; Peginterferon alfa-2b; Ribavirin

MeSH Terms

Anemia
Exanthema
Genotype
Hepatitis C
Hepatitis C, Chronic
Hepatitis, Chronic
Humans
Interferon-alpha
Interferons
Korea
Leukopenia
Polyethylene Glycols
Pruritus
Recombinant Proteins
Retrospective Studies
Ribavirin
Interferon-alpha
Interferons
Polyethylene Glycols
Recombinant Proteins
Ribavirin

Figure

• 

  Fig. 1 Virologic response of pegylated interferon and ribavirin. RVR 61.8%, EVR 82.5%, ETR 88.9%, SVR 80.5%.

Reference

1. Global surveillance and control of hepatitis C. Report of a WHO consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Hepat. 1999. 6:35–47.

2. Lim YS. Current status of liver disease in Korea: hepatitis C. Korean J Hepatol. 2009. 15:S25–S28.

3. Chung RT. Acute hepatitis C virus infection. Clin Infect Dis. 2005. 41:S14–S17.

4. Seeff LB. Natural history of chronic hepatitis C. Hepatology. 2002. 36:S35–S46.

5. Ishikawa T, Higuchi K, Kubota T, Seki K, Honma T, Yoshida T, et al. Combination PEG-IFN a-2b/Ribavirin therapy following treatment of hepatitis C virus-associated hepatocellular carcinoma is capable of improving hepatic functional reserve and survival. Hepatogastroenterology. 2012. 59:529–532.

6. Poynard T, McHutchison J, Davis GL, Esteban-Mur R, Goodman Z, Bedossa P, et al. Impact of interferon alfa-2b and ribavirin on progression of liver fibrosis in patients with chronic hepatitis C. Hepatology. 2000. 32:1131–1137.

7. Strader DB, Wright T, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C. Hepatology. 2004. 39:1147–1171.

8. European Association for the Study of the Liver. EASL international consensus conference on hepatitis C. Paris, 26-28, February 1999, Consensus Statement. J Hepatol. 1999. 30:956–961.

9. Lee HS, Lee JH, Choi MS, Kim CY. Comparison of the incidence of hepatocellular carcinoma in HBV-and HCV-associated liver cirrhosis; A prospective study. Korean J Hepatol. 1996. 2:21–28.

10. Choo QL, Kuo G, Weiner AJ, Overby LR, Bradley DW, Houghton M. Isolation of a cDNA clone derived from a blood-born non-A, non-B viral hepatitis genome. Science. 1989. 244:359–362.

11. Lee HJ, Suh JI, Park CW. Efficacy of treatment with interferon alpha in hepatitis C. Korean J Hepatol. 1996. 2:166–175.

12. Yoon BC, Kim HJ, Kim KS, Yoo HD, Lee SU, Han BH. Therapeutic efficacy of combination therapy with Alpha Interferon and Ribavirin in chronic hepatitis C. Korean J Gastroenterol. 2001. 37:203–209.

13. Suh DJ, Park NH, Chung YH, Lee YS. Efficacy of combination of Interferon α 2a , Ribavirin and UDCA in the treatment of chronic hepatitis C. Korean J Hepatol. 1998. 4:109–119.

14. Choi WH, Paik SW, Choi MS, Lee JH, Koh KC, Yoo BC. Treatment of hepatitis C naive Patients according to EASL Recommendations in Korea. Korean J Hepatol. 2003. 9:S53.

15. Manns MP, McHutchinson JG, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, 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. 358:958–965.

16. Shepherd J, Brodin H, Cave C, Waugh N, Price A, Gabbay J. Pegylated interferon alpha-2a and -2b in combination with ribavirin in the treatment of chronic hepatitis C: a systematic review and economic evaluation. Health Technol Assess. 2004. 8:1–125.

17. Itakura J, Asahina Y, Tamaki N, Hirayama I, Yasui Y, Tanaka T, et al. Changes in hepatitis C viral load during first 14 days can predict the undetectable time point of serum viral load by pegylated interferon and ribavirin therapy. Hepatol Res. 2011. 41:217–224.

18. Mach TH, Cieśla A, Warunek W, Janas-Skulina U, Cibor D, Owczarek D, et al. Efficacy of pegylated interferon alfa-2a or alfa-2b in combination with ribavirin in the treatment of chronic hepatitis caused by hepatitis C virus genotype 1b. Pol Arch Med Wewn. 2011. 121:434–439.

19. Zeuzem S, Feinman SV, Rasenack J, Heathcote EJ, Lai MY, Gane E, et al. Peginterferon alfa-2a in patients with chronic hepatitis C. N Engl J Med. 2000. 343:1666–1672.

20. Sinn DH, Shin SR, Kil JS, Kim J, Gwak GY, Choi MS, et al. Efficacy of peg-interferon-a-2a plus ribavirin for patients aged 60 years and older with chronic hepatitis C in Korea. J Gastroenterol Hepatol. 2011. 26:469–476.

21. Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Goncales FL Jr, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 2002. 347:975–982.

22. Lee H, Choi MS, Paik SW, Kim JH, Kim DY, Lee JH, et al. Peginterferon Alfa-2a plus Ribavirin for initial treatment of chronic hepatitis C in Korea. Korean J Hepatol. 2006. 12:31–40.

23. Sinn DH, Paik SW, Kang P, Kil JS, Park SU, Lee SY, et al. Disease progression and the risk factor analysis for chronic hepatitis C. Liver Int. 2008. 28:1363–1369.

24. Yu ML, Chuang WL. Treatment of chronic hepatitis C in Asia: when East meets West. J Gastroenterol Hepatol. 2009. 24:336–345.

25. Jung YS, Park HB, Oak CH, Jang YK, Yun BC, Ahn SY, et al. The usefulness of histopathological severity index in predicting the response to Alpha-interferon in patients with chronic hepatitis C. Korean J Gastroenterol. 1999. 34:496–502.

26. Chew KW, Allen SA, Taylor LE, Rich JD, Feller E. Treatment outcomes with Pegylated interferon and Ribavirin for male prisoners with chronic hepatitis C. J Clin Gastroenterol. 2009. 43:686–691.

27. Ferenci P, Brunner H, Laferl H, Scherzer TM, Maieron A, Strasser M, et al. A randomized, prospective trial of Ribavirin 400 mg/day versus 800 mg/day in combination with Peginterferon alfa-2a in hepatitis C virus genotypes 2 and 3. Hepatology. 2008. 47:1816–1823.