Lead-in treatment with interferon-β/ribavirin may modify the early hepatitis C virus dynamics in pegylated interferon alpha-2b/ribavirin combination for chronic hepatitis C patients with the IL28B minor genotype

Norio Itokawa, Masanori Atsukawa, Akihito Tsubota, Chisa Kondo, Satomi Hashimoto, Takeshi Fukuda, Yoko Matsushita, Hideko Kidokoro, Tamaki Kobayashi, Yoshiyuki Narahara, Katsuhisa Nakatsuka, Hidenori Kanazawa, Katsuhiko Iwakiri, Choitsu Sakamoto
Journal of Gastroenterology and Hepatology 2013, 28 (3): 443-9

BACKGROUND AND AIM: The most important factor influencing the effect of pegylated interferon (PEG-IFN)/ribavirin therapy (PEG) for chronic hepatitis C genotype 1b with high viral load is the interleukin 28B (IL28B) genotype. We investigated the usefulness of lead-in twice-daily interferon (IFN)-β/ribavirin therapy (IFN-β), and the early hepatitis C virus RNA (HCV-RNA) dynamics was compared between PEG and IFN-β groups according to the IL28B genotype.

METHODS: Forty-six patients were randomly allocated to PEG and IFN-β groups, and HCV-RNA dynamics in an early phase of treatment were analyzed.

RESULTS: The patients with minor IL28B genotype was 6/23 and 8/23 in IFN-β and PEG groups, respectively. In the patients with IL28B major genotype, viral load reduction was marginally greater in IFN-β group than in PEG group. In contrast, in the patients with the IL28B minor genotype, viral load reduction was significantly and numerically greater in IFN-β group than in PEG group at 1 week (2.07 vs. 0.76 log IU/mL, P = 0.038), 2 weeks (2.73 vs. 1.01, P = 0.009), 4 weeks (2.72 vs. 1.55, P = 0.059), and 12 weeks (4.56 vs. 3.24, P = 0.104). The sustained virological response rates in the IL28B major genotype were similar between IFN-β group (47.1%, 8/17) and PEG group (53.3%, 8/15). In contrast, the sustained virological response rates in the IL28B minor genotype were numerically higher in IFN-β group (50.0%, 3/6) than in PEG group (12.5%, 1/8), although not statistically significant.

CONCLUSION: It was suggested that lead-in twice-daily IFN-β/ribavirin treatment followed by PEG-IFN/ribavirin combination therapy may modify the HCV-RNA dynamics compared with that by PEG-IFN/ribavirin therapy, and it is particularly useful for the IL28B minor genotype.

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