Prediction of sustained virological response in chronic hepatitis C patients
treated with peginterferon alfa-2a (40KD) and ribavirin.
 a.. Foster GR,
 b.. Fried MW,
 c.. Hadziyannis SJ,
 d.. Messinger D,
 e.. Freivogel K,
 f.. Weiland O.
The Royal London Hospital, London, UK. g.r.foster@qmul.ac.uk

OBJECTIVE: Patient- and virus-related factors influence the response of
patients with chronic hepatitis C to interferon-based therapy. The purpose
of this study was to model the probability of achieving a sustained
virological response in individual patients, taking into consideration
various predictive factors.

MATERIAL AND METHODS: We combined data from two randomized, multinational
trials in which patients received peginterferon alfa-2a (40KD) plus
ribavirin. The logistic regression model for patients infected with
hepatitis C virus genotype 1 included age, viral load, histology, alanine
aminotransferase quotient, body mass index, treatment duration, ribavirin
dose and adherence.

RESULTS: In the genotype 1 model, varying baseline factors had a striking
effect on the probability of sustained virological response. A dramatic
difference in the probability of sustained virological response was seen in
a series of hypothetical patients in whom five factors were varied to
represent best and worst case scenarios.

The best case scenario (age 20 years; no cirrhosis/bridging fibrosis;
alanine aminotransferase quotient=7; body mass index 20 kg/m2; viral load
40,000 IU/mL) was associated with a 97% probability of sustained virological
response, compared with 7% in the worst case scenario (age 60 years;
cirrhosis/bridging fibrosis; alanine aminotransferase quotient=1; body mass
index 30 kg/m2; viral load 9,000,000 IU/mL). Both adherence to treatment and
achieving an early virological response increased the probability of
sustained virological response.

CONCLUSIONS: In treatment-naive patients with chronic hepatitis C, host
factors play a major role in determining treatment outcome and the logistic
regression model is useful for predicting the probability of sustained
virological response in individual patients.

PMID: 17327945 [PubMed - indexed for MEDLINE]