HCV Treatment — How Short Can We Go?

Patients infected with hepatitis C virus (HCV) genotypes 2 and 3 tend to be very responsive to combination therapy with pegylated interferon and ribavirin. Consequently, current guidelines recommend 24 weeks of treatment for such patients, in contrast to the 48 weeks recommended for patients infected with genotype 1. Could treatment for HCV genotypes 2 and 3 be shortened even further — to 16 weeks?

In a manufacturer-supported, randomized trial involving 1469 patients infected with HCV genotypes 2 or 3, investigators compared 16- and 24-week courses of treatment with peginterferon alfa-2a (180 µg once weekly) and ribavirin (400 mg twice daily).

A higher percentage of patients completed the full course of treatment in the 16-week arm than in the 24-week arm (94% vs. 87%). However, in an intention-to-treat analysis, the sustained virologic response rate 24 weeks after completion of treatment was significantly lower with 16 weeks of therapy than with 24 weeks (62% vs. 70%); similar results were found in a per-protocol analysis (65% vs. 76%). The following factors were predictive of sustained virologic response: 24 weeks of therapy, infection with HCV genotype 2, pretreatment serum HCV RNA level <400,000 IU/mL, age ≤45, weight ≤80 kg, elevated alanine aminotransaminase levels, and absence of bridging fibrosis or cirrhosis. Patients with rapid virologic responses (at 4 weeks) also had higher rates of sustained virologic response. The incidence of adverse events was similar between groups; 4% of the 16-week group and 5% of the 24-week group were withdrawn from treatment because of adverse events or laboratory abnormalities.