Details

Autor(en) / Beteiligte

• FERNANDEZ-RODRIGUEZ, Conrado M
• ALONSO, Sonia
• FERNANDEZ, Inmaculada
• GARCIA-SAMANIEGO, Javier
• FUENTE, Javier
• SOLA, Ricard
• MORENO-OTERO, Ricardo
• PLANAS, Ramón
• MARTINEZ, Stella M
• FORNS, Xavier
• SANCHEZ-TAPIAS, Jose M
• RINCON, Diego
• RODRIGUEZ-CARAVACA, Gil
• BARCENA, Rafael
• SERRA, Miguel A
• ROMERO-GOMEZ, Manuel

Titel

Peginterferon Plus Ribavirin and Sustained Virological Response in HCV-Related Cirrhosis: Outcomes and Factors Predicting Response

Ist Teil von

• The American journal of gastroenterology, 2010-10, Vol.105 (10), p.2164-2172

Ort / Verlag

Basingstoke: Nature Publishing Group

Erscheinungsjahr

2010

Quelle

MEDLINE

Beschreibungen/Notizen

• Patients with hepatitis C virus (HCV) cirrhosis are difficult to treat and have a high risk of liver decompensation or hepatocellular carcinoma. We sought to identify factors that could predict treatment response. Collaborating centers (n=26) provided data for patients (n=568) with HCV cirrhosis undergoing treatment with peginterferon-α plus ribavirin (RBV). Univariate and multivariate analyses were used to evaluate factors predicting treatment outcomes. Sustained viral response (SVR) in naive patients was 30.7%, with no significant differences between centers. Median follow-up was 35 months (range: 1-81). Factors predicting SVR were: non-genotype 1 (odds ratio (OR)=4.183; 95% confidence interval (CI): 2.353-7.438) overall dose and ≥80% of the scheduled time of treatment (OR=3.177; 95% CI: 1.752-5.760); serum γ-glutamyl transpeptidase (GGT) <76 IU per ml (OR=4.092; 95% CI: 2.418-6.927); baseline viral load <6 × 10(5) (OR=2.597; 95% CI: 1.583-4.262); absence of ultrasound signs of portal hypertension (OR=2.067; 95% CI: 1.26-3.39). No patient with a HCV-RNA decline <1 log(10) at week 4 achieved SVR. Event-free survival at 5 years was 91% in patients with SVR vs. 59% in non-responders (P<0.001). Overall survival in patients with SVR was 98% vs. 86% in non-responders (P=0.005). Independent factors predicting events were absence of SVR (hazard ratio (HR)=2.66; 95% CI: 1.32-5.54), baseline serum albumin <3.9 g per 100 ml (HR=3.06; 95% CI: 1.81-5.15), presence of esophageal varices on endoscopy (HR=2.489; 95% CI: 1.546-4). Improved outcome was more evident in responders with less advanced disease at baseline. SVR can be achieved in approximately one-third of patients with HCV-related cirrhosis. SVR independently reduces the likelihood of clinical decompensation and improves survival.