Key result
Platelet count <140,000 mm3 (OR 2.51; 95% CI 1.49-4.20) and BMI ≥30 (OR 1.7; 95% CI 1.03-2.70) were independently associated with relapse after a 12-week course of antiviral therapy.
Why the study?
What are the predictors of relapse after a 12-week course of antiviral therapy in patients with HCV genotype 2 or 3 who achieve rapid virological response?
Cohort (n=718)
What are the predictors of relapse after a 12-week course of antiviral therapy in patients with HCV genotype 2 or 3 who achieve rapid virological response?
In patients with HCV genotype 2 or 3 who achieve rapid virological response, a shortened 12-week course of antiviral therapy is effective and recommended for those with low BMI and no advanced fibrosis.
Answers are grounded in this paper and cite their sources.
Low platelet count and high BMI were associated with relapse after 12-week therapy in RVR patients; leaves open whether extended courses improve outcomes in these subgroups.
UNLABELLED: In hepatitis C virus (HCV) genotypes 2 and 3 patients, the high rate of relapse after 12 to 16 weeks of antiviral therapy is the main concern for shortening treatment duration. This study was undertaken to delineate predictors of relapse after short treatment in patients with undetectable HCV RNA at treatment week 4 (RVR), and to report in RVR patients with relapse the sustained virological response (SVR) after a second 24-week course of therapy. RVR patients received pegylated interferon (Peg-IFN) alfa-2b (1.5 microg/kg) and ribavirin (1000-1200 mg/day) for 12 weeks; those who relapsed were re-treated with the same drug doses but for the extended standard duration of 24 weeks. Logistic regression analysis was applied to delineate predictors of relapse by using age, sex, route of transmission, body mass index (BMI), serum alanine aminotransferase (ALT), HCV genotypes, serum HCV RNA levels, and platelet counts as covariates. Of 718 patients with genotypes 2 and 3 who were started on therapy, 496 (69.1%) had undetectable HCV RNA at week 4. Of them, 409 patients (82.5%, CI 79.1-85.8) attained SVR, and 67 (14.1%, CI 10.4-16.5) relapsed. At regression analysis, only platelet count less than 140,000 mm(3) [odds ratio, 2.51; confidence interval (CI), 1.49-4.20] and BMI 30 or higher (odds ratio, 1.7; CI, 1.03-2.70) were independently associated with relapse. Forty-three of 67 patients with relapse agreed to be re-treated, and an SVR was achieved in 30 (70.0%) of them. CONCLUSION: We recommend 12 weeks course of therapy for patients with undetectable HCV RNA at treatment week 4, providing they present with no advanced fibrosis and low BMI.
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Mangia et al. (2008) conducted a cohort in chronic hepatitis C virus genotype 2 or 3 infection (n=718). Platelet count <140,000 mm3 vs. Platelet count ≥140,000 mm3 was evaluated on relapse (OR 2.51, 95% CI 1.49-4.20). Platelet count <140,000 mm3 (OR 2.51; 95% CI 1.49-4.20) and BMI ≥30 (OR 1.7; 95% CI 1.03-2.70) were independently associated with relapse after a 12-week course of antiviral therapy.
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