28876
document
Impact of disease severity on outcome of antiviral therapy for chronic hepatitis C : Lessons from the HALT-C trial . In patients with chronic hepatitis C , advanced fibrosis and cirrhosis are associated with lower rates of sustained virologic response ( SVR ) to interferon ( IFN ) -based therapy . In this study , we assessed virologic response to retreatment with peginterferon alfa-2a and ribavirin ( RBV ) , as a function of the baseline fibrosis score ( Ishak staging ) and platelet count , in 1,046 patients enrolled in the Hepatitis C Antiviral Long-term Treatment against Cirrhosis ( HALT-C ) Trial . All patients had failed prior treatment with IFN or peginterferon +/- RBV and had Ishak fibrosis scores > or = 3 . Four groups of patients with increasingly severe liver disease were compared : ( A ) bridging fibrosis ( Ishak 3 and 4 ) with platelet counts > 125,000/mm3 ( n = 559 ) ; ( B ) bridging fibrosis with platelet counts < or =125,000/mm3 ( n = 96 ) ; ( C ) cirrhosis ( Ishak 5 and 6 ) with platelet counts > 125,000/mm3 ( n = 198 ) ; and ( D ) cirrhosis with platelet counts < or =125,000/mm3 ( n = 193 ) . SVR rates were 23 % , 17 % , 10 % , and 9 % in groups A , B , C , and D , respectively ( P < .0001 for trend ) . Reduction in SVR as a function of increasingly severe disease was independent of age , percent African American , HCV genotype , HCV level , and type of prior therapy . Dose reduction lowered SVR frequencies , but to a lesser extent than disease severity . By logistic regression , cirrhosis ( P < .0001 ) was the major determinant that impaired virologic response , independent of dose reduction or platelet count . In conclusion , disease severity is a major independent determinant of rate of SVR in patients with advanced chronic hepatitis C. New strategies are needed to optimize antiviral therapy in these " difficult-to-cure " patients .
28877
Intervention_Pharmacological
antiviral therapy
28878
Intervention_Pharmacological
peginterferon alfa-2a
28879
Intervention_Pharmacological
ribavirin ( RBV )
28880
Intervention_Pharmacological
IFN
28881
Intervention_Pharmacological
peginterferon +/- RBV
28882
Outcome_Physical
sustained virologic response ( SVR )
28883
Outcome_Physical
virologic response
28884
Outcome_Physical
SVR rates
28885
Outcome_Physical
Reduction in SVR
28886
Outcome_Physical
SVR frequencies
28887
Outcome_Physical
cirrhosis
28888
Outcome_Physical
virologic response
28889
Outcome_Physical
rate of SVR
28890
Participant_Condition
chronic hepatitis C :
28891
Participant_Condition
patients with chronic hepatitis C , advanced fibrosis and cirrhosis are associated with lower rates of sustained virologic response ( SVR ) to interferon ( IFN ) -based therapy
28892
Participant_Sample-size
1,046 patients
28893
Participant_Sample-size
Four groups
28894
Participant_Condition
severe liver disease were compared
28895
Participant_Condition
patients with advanced chronic hepatitis C.