Pegylated
Interferon plus Ribavirin Can Effectively Treat both Hepatitis
B and C In Dually Infected Patients
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| SUMMARY:
Combination therapy using pegylated
interferon plus ribavirin produced both sustained
hepatitis C virus (HCV) suppression and hepatitis
B surface antigen (HBsAg) clearance in patients
dually infected with both viruses, according to
a study presented this month at the 60th Annual
Meeting of the American Association for the Study
of Liver Diseases (AASLD
2009) in Boston. |
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By
Liz Highleyman
Due
to overlapping routes of transmission, many people are coinfected
with both hepatitis B
and C, a combination that
increases the risk of liver disease progression.
Researchers
from Taiwan previously found that HBV/HCV coinfected patients
had a relatively high (11%) rate of HBsAg clearance 6 months
after completing standard hepatitis C treatment using pegylated
interferon alfa-2a (Pegasys) plus ribavirin; pegylated
interferon is also an approved therapy for chronic hepatitis
B. That study also showed that sustained virological response
rates were similar in HCV monoinfected and HBV/HCV coinfected
patients.
In
the present analysis, the investigators sought to determine
whether the rate of HBsAg clearance increased during long-term
follow-up of coinfected patients in the initial study.
A
total of 161 initially HBsAg positive patients with hepatitis
C were treated with 180 mcg/week pegylated interferon alfa-2a
plus 1000/1200 mg/day weight-adjusted ribavirin for 48 weeks
if they had HCV
genotype 1, or 800 mg/day ribavirin for 24 weeks if
they had genotype
2 or 3. Of these participants, 108 were still available
for follow-up 1.5 years after completing treatment.
Results
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1.5
years after completing hepatitis C therapy: |
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91
patients (84%) had undetectable HCV RNA; |
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51
patients (47%) had undetectable HBV DNA; |
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41
patients (38%) had undetectable levels of both
viruses. |
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17
participants (16%) were considered to have cleared HBsAg,
with levels < 0.05 IU/mL. |
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A
majority of these patients (12 of 17) had HBsAg levels
< 10 IU/mL at baseline. |
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9
of the 17 patients with HBsAg clearance also had undetectable
HBV DNA (the remainder had HBV DNA < 2000 IU/mL)
and 8 had sustained undetectable HCV RNA. |
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HBsAg
clearance was observed in patients with HBV genotypes
B and C. |
Based
on these findings, the investigators concluded, "Combination
therapy of Pegasys and ribavirin is effective for treatment
of patients dually infected with HCV and HBV and can result
in successful treatment of both chronic viral infections."
They
continued, "The high rates of HBsAg clearance -- the
closest outcome to cure in chronic hepatitis B -- coupled
with the similar sustained virologic response rates in HCV/HBV
coinfection compared with HCV monoinfection, suggests that
peginterferon alfa-2a and ribavirin combination therapy
is an effective first-line treatment strategy for this patient
group."
National
Taiwan University College of Medicine, Taipei, Taiwan; Kaohsiung
Medical University Hospital, Kaohsiung, Taiwan; Chang Gung
Memorial Hospital-Kaohsiung, Kaohsiung, Taiwan; Changhua
Christian Hospital, Changhua, Taiwan; Taipei City Hospital,
Ren-Ai Branch, Taipei, Taiwan; Chi Mei Medical Center, Tainan,
Taiwan; Tri-Service General Hospital, Taipei, Taiwan; Chai-Yi
Chang Gung Memorial Hospital, Chiayi, Taiwan; Cathay General
Hospital, Taipei, Taiwan.
11/17/09
Reference
C
Liu, W Chuang, C Lee, and others. HBsAg clearance continues
to increase post-treatment in patients with HCV/HBV coinfection
treated with peginterferon alfa-2a plus ribavirin: 1.5 year
follow-up. 60th Annual Meeting of the American Association
for the Study of Liver Diseases (AASLD 2009). Boston. October
30-November 1, 2009. Abstract 419.
