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 18 February 2018

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Shorter therapy with ribavirin in Hep C genotype 2 or 3

A shorter course of therapy over 12 weeks with peginterferon alfa-2b and ribavirin is as effective as a 24-week course for patients with Hepatitis C genotype 2 or 3, reports this week's New England Journal of Medicine.

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Dr Alessandra Mangia and colleagues from Italy assessed patients with Hepatitis C virus genotype 2 or 3 in whom the Hep C RNA is not detectable.

The researchers hypothesized that after 4 weeks of therapy, 12 weeks of treatment is as effective as 24 weeks.

The research team randomly assigned a total of 283 patients to a standard 24-week regimen of peginterferon alfa-2b at a dose of 1.0 µg kg-1 weekly.

The patients were also given ribavirin at a dose of 1000 mg or 1200 mg daily, on the basis of body weight.

76% in the standard-duration Group had a sustained virologic response vs 77% in the variable-duration Group
NEJM

The team reported that of the 283 patients, 70 were assigned to the 24-week regimen, the standard-duration Group.

The researchers also assigned 213 patients to a variable regimen, the variable-duration Group of 12 or 24 weeks.

The allocation to groups depended on whether tests for Hepatitis C RNA were negative or positive at week 4.

The primary end point was Hepatitis C that was not detectable by polymerase-chain-reaction assay 24 weeks after the completion of therapy.

The researchers found that in the standard-duration Group, 64% had Hepatitis C that was not detectable by polymerase-chain-reaction assay at week 4.

The team compared this with 62% in the variable-duration Group.

The researchers noted that 76% in the standard-duration Group and 77% in the variable-duration Group had a sustained virologic response.

Fewer patients in the variable-duration Group receiving the 12-week regimen had adverse events and withdrew than in the group receiving the 24-week regimen.

The team defined the rate of relapse as Hepatitis C not detectable at the end of treatment but detectable at the end of follow-up.

The rate of relapse was a reported 4% in the standard-duration Group and 9% in the variable-duration Group.

Overall, the team observed an 80% rate of sustained virologic response among patients with Hepatitis C genotype 2 and 66% among those with genotype 3.

Dr Mangia's team concluded, “A shorter course of therapy over 12 weeks with peginterferon alfa-2b and ribavirin is as effective as a 24-week course for patients with Hepatitis C genotype 2 or 3 who have a response to treatment at 4 weeks.”

NEJM 2005: 352: 2609-17
24 June 2005

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