不同療程之長效型干擾素合併雷巴威林治療慢性C型肝炎病毒基因型第一型之療效分析

The Analysis of Different Course of Treatment with Pegylated Interferon plus Ribavirin for Genotype 1 Hepatitis C Virus

張秋純(Chiu-Chun Chang) ； 林俊哲(Chun-Che Lin) ； 陳滋彥(Tzy-Yen Chen) ； 陳丹霞(Tan-Hsia Chen) ； 蔡明璋(Ming-Chang Tsai) ； 楊凱凡(Kai-Fuan Yeo) ； 林敬斌(Ching-Bin Lin) ； 張明輝(Ming-Hui Chang)

《中山醫學雜誌》 21卷4期 (2010/12) Pp. 381-396

https://doi.org/10.30096/CSMJ.201012.0005

摘要

Prolonged duration and dose of pegylated interferon and ribavirin after 48 weeks of treatment to maximinze SVR in HCV genotype 1-infected patients is recommended. In Taiwan, payment of treatment from National Health Insurance system is limited to 24 weeks therapy. We aimed to determine the feasibility of different courses of treatment with pegylated interferon plus ribavirin in patients infected with HCV genotype 1. From March 2003 to March 2008, 91 patients with HCV genotype 1 received pegylated interferon weekly as well as weigh-base ribavirin daily for either 24(n=33), 36(n=28) or 48(n=30) weeks. Normalization of ALT and sustained viral response 24 weeks after end of treatment were recorded and analyzed. Cost effectiveness and adverse drug effect were also recorded. Results: The end-of-follow-up response was 36.3% for 24 weeks treatment, 57.1% for 36 weeks treatment, and 63.3% for 48 weeks treatment. The rate of ALT normalization was 70% for 24 weeks, 82.1% for 36 weeks, and 76.7% for 48 weeks. Twenty-four weeks of therapy was inferior to 48 weeks in achievement of sustained viral response rates (p＜0.05). There was no significant difference in the SVR rate between patients treated for 36 weeks and 48 weeks. We found an association between early fibrosis stage and therapy for more than 36 weeks with more durable treatment effects. Conclusion. The efficacies of 36 weeks pegylated interferon plus ribavirin treatment for patients infected with HCV genotype 1 is comparable to 48 weeks therapy. Larger studies are needed to elucidate the cost-effectiveness of these therapies.

關鍵字

C型肝炎 ； 病毒基因型第一型 ； 治療

並列摘要

Prolonged duration and dose of pegylated interferon and ribavirin after 48 weeks of treatment to maximinze SVR in HCV genotype 1-infected patients is recommended. In Taiwan, payment of treatment from National Health Insurance system is limited to 24 weeks therapy. We aimed to determine the feasibility of different courses of treatment with pegylated interferon plus ribavirin in patients infected with HCV genotype 1. From March 2003 to March 2008, 91 patients with HCV genotype 1 received pegylated interferon weekly as well as weigh-base ribavirin daily for either 24(n=33), 36(n=28) or 48(n=30) weeks. Normalization of ALT and sustained viral response 24 weeks after end of treatment were recorded and analyzed. Cost effectiveness and adverse drug effect were also recorded. Results: The end-of-follow-up response was 36.3% for 24 weeks treatment, 57.1% for 36 weeks treatment, and 63.3% for 48 weeks treatment. The rate of ALT normalization was 70% for 24 weeks, 82.1% for 36 weeks, and 76.7% for 48 weeks. Twenty-four weeks of therapy was inferior to 48 weeks in achievement of sustained viral response rates (p＜0.05). There was no significant difference in the SVR rate between patients treated for 36 weeks and 48 weeks. We found an association between early fibrosis stage and therapy for more than 36 weeks with more durable treatment effects. Conclusion. The efficacies of 36 weeks pegylated interferon plus ribavirin treatment for patients infected with HCV genotype 1 is comparable to 48 weeks therapy. Larger studies are needed to elucidate the cost-effectiveness of these therapies.

並列關鍵字

hepatitis C virus ； genotype 1 ； treatment