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Canadian Journal of Gastroenterology
Volume 17, Issue 8, Pages 483-487
Original Article

Early Prediction of Nonresponders to Treatment with Interferon Alpha-2B and Ribavirin in Patients with Chronic Hepatitis C

Louis WC Liu,1 George Tomlinson,2 Tony Mazzulli,3 Alison Murray,4 and Jenny Heathcote5

1Department of Medicine, McMaster University, Hamilton, Ontario, Canada
2University Health Network, Department of Clinical Epidemiology, Canada
3Toronto Medical Labs/Mount Sinai Hospital, Department of Microbiology, Toronto, Ontario, Canada
4Glaxo SmithKline, Greenford, UK
5University Health Network, Department of Medicine, Toronto, Ontario, Canada

Received 19 November 2002; Revised 22 May 2003

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Treatment of chronic hepatitis C virus (HCV) infection with interferon alpha-2b and ribavirin is costly in terms of side effects, medical resources and drug costs. Furthermore, less than 50% of patients overall have a sustained virological response (SVR).

OBJECTIVE: To determine if the log fall in HCV RNA between baseline and week 1 (b-wk1) and between baseline and week 4 (b-wk4) after starting treatment could identify the nonresponders.

PATIENTS AND METHODS: Sixty-three patients who had completed a full course of therapy were identified. Quantitative measurements of HCV RNA were analyzed from stored sera, collected prospectively.

RESULTS: SVR was achieved in 47.1% and 47.3% of patients in the b-wk1 and b-wk4 groups, respectively. No patients had an SVR with a fall in HCV RNA of less than 0.35 log10 and 1.05 log10 at week 1 and week 4, respectively. This accounted for 44.4% and 51.7% of the nonresponders in the b-wk1 and b-wk4 groups, respectively. Once the decline in viral load was known, genotype, age, sex and baseline viral load did not provide additional power in predicting treatment responses.

CONCLUSION: A fall of 1.05 log10 in HCV RNA at week 4 predicts those patients who will not respond, identifying one-half of all nonresponders; this allows therapy to be stopped early, without depriving any patient who would have an SVR from treatment.