5/10/2007 - Prior large, multicenter trials have reported sustained virological response (SVR) rates of 45%-80% in individuals with chronic hepatitis C. However, few data are available concerning whether similar SVR rates are achieved in "real world" settings (outside clinical trials), and to what extent success rates depend on supervision by expert hepatologists.
German researchers at the University of Dusseldorf conducted a retrospective study that analyzed these issues among patients at their outpatient clinics during May 1997 and March 2004 who received at least 1 dose of interferon-based treatment.
Results
A total of 302 treatment-naive HCV were included in the analysis.
215 patients (72%) had HCV genotype 1 or 4, 78 (25%) had genotype 2 or 3, and 9 (3%) had an undetermined genotype.
Of these 302 patients, 196 consulted an expert hepatologist at least once every 3 months during treatment (regular visitors), whereas 106 patients had their treatment performed and supervised by a general practitioner (irregular visitors).
The 2 patient groups did not differ in their baseline characteristics.
Virological response rates at the end of treatment (ETR; 74% vs 48%; P < 0.001) and 6 months thereafter (SVR; 66% vs 34%; P < 0.001) were significantly higher in regular visitors.
In patients treated with pegylated interferon plus ribavirin, this difference was highly statistically significant (P < 0.001) for those with HCV genotypes 1 and 4 (SVR 61% vs 27%; P < 0.001), but not for those with genotypes 2 and 3.
SVR rates were also significantly higher in regular visitors with advanced liver damage (SVR 69% vs 25%; P = 0.004).
Among regular and irregular visitors, 7% and 15%, respectively, discontinued treatment prematurely (P = 0.015).
Conclusion
These results led the study authors to conclude, "Patients with…genotypes 1 and 4 or with advanced liver damage benefit from HCV therapy supervision by a specialist, probably because of less frequent treatment interruptions or dose reductions."
Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf, Moorenstr, Düsseldorf, Germany.
10/05/07
Reference
A Sagir, T Heintges, Z Akyazi, and others. Therapy outcome in patients with chronic hepatitis C: role of therapy supervision by expert hepatologists. Journal of Viral Hepatitis 14(9): 633-638. September 2007.
