THE IDEAL CUT-OFF OF VIREMIA LEVELS IN TREATING HCV-RELATED
CHRONIC HEPATITIS TO IMPROVE THE COST/BENEFIT RATIO OF INTERFERON
THERAPY
F Morisco, R Marmo, C Tuccillo, P Iasevoli, G Sessa, N Caporaso
Department of Internal Medicine, II University of Naples, Italy
The main objective of managing HCV-related chronic liver disease
treated with Interferon (IFN) is to accurately select patients who
will experience a sustained beneficial response and to optimize the
cost/benefit likelihood of therapeutic strategy. The independent
predictive parameters of long-term response (LTR) estimated by
logistic regression analysis are non-1b viral genotype and low
initial viremia levels. In particular, low initial viremia levels
seem to be the best predictive factor. But presently, the "exact"
level of viremia which separates the long-term responders from
other patients is not know.
Patients and Methods: We assayed the pretreatment levels of
HCV-viremia (b-DNA, Chiron) in 76 patients (M/F 48/28, median age
50, range 18-65) with biopsy-proven chronic type C hepatitis. The
treatment schedule was 6 MU of r-alpha IFN (3 times weekly) for 16
weeks and then for another 32 weeks (only in those whose alanine
aminotransferase levels normalized). The statistical analysis was
performed using Median test. Results: In our patients' population,
the median level of viremia was 23.64 Eq/ml x 10Ø{5}. The
table shows the distribution of patients in relation to viremia
levels and type of response to IFN.
HCV-RNA LTR RR NR p Eq/ml x 10Ø{5}
<=23.64 13 8 17
>23.64 1 12 25 <0.0018
Long Term Response (LTR), Response with Relapse (RR), No Response (NR)
The 23.64 Eq/ml x 10Ø{5} value of viremia is the best level
to distinguish LTR from NR and RR; no patients with >3 x
10Ø{6} Eq/ml levels had an LTR. Conclusions: based on these
findings, we suggest not to use IFN (or at least not alone) to
treat patients whose viremia levels are high (> 3 x 10Ø{6}
Eq/ml). This approach can reduce the number of futile treatments
and improve the cost/benefit ratio of IFN therapy.
Source: American Association for the Study of Liver Diseases
- 1996 Annual Meeting
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