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Short interferon and ribavirin treatment for HCV genotype 2 or 3 infection: NORDynamIC trial and real-life experience

Journal article
Authors Jesper Waldenström
M. Farkkila
Karolina Rembeck
Gunnar Norkrans
N. Langeland
K. Morch
C. Pedersen
M. Rauning Buhl
U. Nieminen
H. Nuutinen
Åsa Alsiö
L. Holmstrom
R. Jungnelius
K. Lund
A. Rubensson
E. Torell
Johan Westin
Martin Lagging
Published in Scandinavian Journal of Gastroenterology
Volume 51
Issue 3
Pages 337-343
ISSN 0036-5521
Publication year 2016
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 337-343
Language en
Links dx.doi.org/10.3109/00365521.2015.10...
Keywords genotype 2, genotype 3, hepatitis C virus, inosine triphosphate pyrophosphatase, interferon, ITPA, chronic hepatitis-c, triphosphate pyrophosphohydrolase deficiency, genetic-basis, sofosbuvir, therapy, population, variants, anemia, Gastroenterology & Hepatology
Subject categories Endocrinology and Diabetes, Internal medicine

Abstract

Objective: Interferon-free therapy for hepatitis C virus (HCV) infection is costly, and therefore patients with advanced fibrosis are prioritized. Although coupled with considerable side effects, a large proportion of genotype 2/3 infected patients achieve a sustained virological response (SVR) following interferon-based therapy. The present study evaluates experimental clinical trial and verifying real-life data with the aim of identifying patients with a high likelihood of favorable outcome following short interferon-based treatment. Material and methods: The impact of established response predictors, e.g. age, ITPA and IL28B genetic variants, IP-10, liver histopathology and early viral kinetics on outcome was evaluated among HCV genotype 2/3 infected patients enrolled in the NORDynamIC trial. Similarly outcome was evaluated among Finnish and Swedish real-life genotype 2/3 infected patients treated for 12-16 weeks in accordance with national guidelines. Results: In the NORDynamIC trial, age <40 years or achieving HCV RNA<1000 IU/mL day 7 were highly predictive of favorable outcome following 12 weeks therapy. Among 255 Finnish real-life patients below the age of 40 years treated for 12 weeks with interferon and ribavirin, 87% of HCV genotype 2 and 79% of genotype 3 infected patients achieved SVR, and among 117 Swedish real-life patients treated for 12-16 weeks, 97% of HCV genotype 2 and 94% of genotype 3 infected achieved SVR. Conclusions: Short interferon-based therapy offers a high likelihood of achieving SVR for selected HCV genotype 2/3 infected patients, and is an acceptable option given that a thorough discussion of the side effects is provided prior to initiation.

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