By Liz Highleyman
Numerous prior studies have shown that people of African descent do not respond as well to interferon-based therapy as white patients, who in turn do not respond as well as Asians. Studies of Hispanic/Latino patients, however, have produced conflicting data.
Sanjaya Satapathy from New York Medical College and colleagues retrospectively evaluated rates of treatment completion and sustained response to pegylated interferon plus weight-adjusted ribavirin in 35 African-American and 68 Hispanic chronic hepatitis C patients; most participants (89% of blacks and 75% of Hispanics) had hard-to-treat HCV genotype 1.
Participants were treated with either 180 mcg/week pegylated interferon alpha-2a (Pegasys) or 1.5 mcg/kg/week pegylated interferon alpha-2b (PegIntron), both with 1000-1200 mg/day ribavirin; patients with HCV genotypes 1 or 4 were treated for 48 weeks while those with genotypes 2 or 3 were treated for 24 weeks. Treatment was discontinued if an individual did not experience at least a 2-log drop in HCV viral load after 12 weeks of treatment.
Results
- Out of 103 initial participants, 50 (49%) discontinued treatment prematurely due to drug side effects, poor adherence, inadequate response, or for other reasons; 44 of them (43%) did not continue beyond 12 weeks of therapy.
- African-American and Hispanic patients had statistically similar discontinuation rates (43% and 52%, respectively).
- Overall, 41% of participants completed the prescribed 24- or 48- week course of treatment.
- Among the patients who completed treatment, overall end-of-treatment response (ETR) rates were 20% for African-Americans and 34% for Hispanics (not a statistically significant difference).
- Overall sustained virological response (SVR) rates 6 months after finishing treatment were 20% for African-Americans and 25% for Hispanics (also not significant).
- Among people with HCV genotype 1, African-Americans and Hispanics had similar low SVR rates, 16% and 14%, respectively.
Overall, both African-Americans and Hispanics "had similar poor response rates, well below those reported for white patients," the study authors concluded. As is true for the general hepatitis C patient population, people with HCV genotypes 2 or 3 had significantly higher ETR and SVR rates.
"A significant proportion of the African-Americans and Hispanics referred for HCV treatment with pegylated interferon dropped out early in the therapy, suggesting possible racial, socioeconomic, and cultural barriers in successful treatment for chronic HCV infection," the investigators added.
Departments of Internal Medicine and Gastroenterology, New York Medical College/Metropolitan Hospital Center; New York, NY; Department of Gastroenterology, Albert Einstein College of Medicine at the Long Island Jewish Medical Center, New York, NY.
4/2/10
Reference
SK Satapathy, CS Lingisetty, S Proper, and others. Equally Poor Outcomes to Pegylated Interferon-based Therapy in African Americans and Hispanics With Chronic Hepatitis C Infection. Journal of Clinical Gastroenterology 44(2): 140-145 (Abstract). February 2010
Source: hivandhepatitis.com
