Atif Zaman, MD, MPH

Identifying patient subpopulations in which combination therapy of peginterferon and ribavirin alone works is one strategy to achieving cost-effectiveness.

With the development of direct antiviral agents for the treatment of hepatitis C virus (HCV) infection, all-oral regimens with pan-genotypic activity, few adverse effects, and high sustained virologic response (SVR) rates will soon be available. However, due to the high cost of the new regimens, the question becomes: Can eradication of HCV infection be achieved cost-effectively? One option would be to treat subpopulations that achieve high SVR rates with only peginterferon and ribavirin (combination therapy).

In a randomized, controlled study, 233 treatment-naive patients with HCV genotype 1, a low baseline viral load (HCV RNA <600,000 IU/mL), and no cirrhosis received peginterferon α-2b (PEG; 1.5 µg/kg/week) and ribavirin (RBV; 1000–1200 mg daily). At 4 weeks, 112 patients (48%) achieved a rapid virologic response. These patients were then randomized to receive either PEG, RBV, and boceprevir (800 mg three times daily) for 24 weeks or PEG and RBV for 20 weeks.

The SVR rates were similar between the triple-therapy and combination-therapy groups, both overall (90% and 88%, respectively) and in stratified analyses by IL28B host genotype, genotype 1 subtype, and ethnicity. Discontinuation rates were similar between the two groups (6% and 8%, respectively).

Citation(s):

Pearlman BL and Ehleben C.Hepatitis C genotype 1 virus with low viral load and rapid virologic response to peginterferon/ribavirin obviates a protease inhibitor. Hepatology 2014 Jan; 59:71.