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      A Predictive Model for Selecting Patients with HCV Genotype 3 Chronic Infection with a High Probability of Sustained Virological Response to Peginterferon Alfa-2a/Ribavirin

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          Abstract

          Background

          Access to direct-acting antiviral agents (DAAs) is restricted in some settings; thus, the European Association for the Study of the Liver recommends dual peginterferon/ribavirin (PegIFN/RBV) therapy wherever DAAs are unavailable. HCV genotype (GT) 3 infection is now the most difficult genotype to eradicate and PegIFN/RBV remains an effective option. The goal of this study was to devise a simple predictive score to identify GT3 patients with a high probability of achieving a sustained virologic response (SVR) with PegIFN alfa-2a/RBV therapy.

          Methods

          Relationships between baseline characteristics and SVR were explored by multiple logistic regression models and used to develop a simple scoring system to predict SVR using data from 1239 treatment-naive GT3 patients who received PegIFN alfa-2a/RBV for 24 weeks in two large observational cohort studies.

          Results

          The score was validated using a database of 473 patients. Scores were assigned for six factors as follows: age (years) (≤40: 2 points; >40 but ≤55: 1); bodyweight (kg) (<70: 2; ≥70 but <90: 1); no cirrhosis/transition to cirrhosis (2); ALT ≤2.5 x ULN (1); platelets (10 9/L) (>200: 2; ≥100 but <200: 1); HCV RNA (<400,000 IU/mL: 1). The points are summed to arrive at a score ranging from 0‒10 where higher scores indicate higher chances of SVR; 141, 123, 203, 249, 232, and 218 patients had total scores of 0‒4, 5, 6, 7, 8, and 9–10, respectively, among whom SVR rates were 45%, 62%, 72%, 76%, 84%, and 89%. Among 622 patients who had scores of 6‒10 and HCV RNA <50 IU/mL by treatment week 4 the SVR rate was 86% (532/622).

          Conclusions

          A simple baseline scoring system involving age, bodyweight, cirrhosis status, ALT level, platelet count and HCV RNA level can be used to identify treatment-naive Caucasian patients with HCV GT3 infection with a high probability of SVR with PegIFN alfa-2a/RBV therapy.

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          Most cited references25

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          Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence.

          In efforts to inform public health decision makers, the Global Burden of Diseases, Injuries, and Risk Factors 2010 (GBD2010) Study aims to estimate the burden of disease using available parameters. This study was conducted to collect and analyze available prevalence data to be used for estimating the hepatitis C virus (HCV) burden of disease. In this systematic review, antibody to HCV (anti-HCV) seroprevalence data from 232 articles were pooled to estimate age-specific seroprevalence curves in 1990 and 2005, and to produce age-standardized prevalence estimates for each of 21 GBD regions using a model-based meta-analysis. This review finds that globally the prevalence and number of people with anti-HCV has increased from 2.3% (95% uncertainty interval [UI]: 2.1%-2.5%) to 2.8% (95% UI: 2.6%-3.1%) and >122 million to >185 million between 1990 and 2005. Central and East Asia and North Africa/Middle East are estimated to have high prevalence (>3.5%); South and Southeast Asia, sub-Saharan Africa, Andean, Central, and Southern Latin America, Caribbean, Oceania, Australasia, and Central, Eastern, and Western Europe have moderate prevalence (1.5%-3.5%); whereas Asia Pacific, Tropical Latin America, and North America have low prevalence (<1.5%). The high prevalence of global HCV infection necessitates renewed efforts in primary prevention, including vaccine development, as well as new approaches to secondary and tertiary prevention to reduce the burden of chronic liver disease and to improve survival for those who already have evidence of liver disease. Copyright © 2012 American Association for the Study of Liver Diseases.
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            EASL Recommendations on Treatment of Hepatitis C 2015.

            (2015)
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              Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose.

              Treatment with pegylated interferon (peginterferon) and ribavirin for 48 weeks is more effective than conventional interferon and ribavirin in patients with chronic hepatitis C. To assess the efficacy and safety of 24 or 48 weeks of treatment with peginterferon-alpha2a plus a low or standard dose of ribavirin. Randomized, double-blind trial. 99 international centers. 1311 patients with chronic hepatitis C. Peginterferon-alpha2a, 180 microg/wk, for 24 or 48 weeks plus a low-dose (800 mg/d) or standard weight-based dose (1000 or 1200 mg/d) of ribavirin. Sustained virologic response: undetectable HCV RNA concentration at the end of treatment and during 12 to 24 weeks of follow-up. Overall and in patients infected with HCV genotype 1, 48 weeks of treatment was statistically superior to 24 weeks and standard-dose ribavirin was statistically superior to low-dose ribavirin. In patients with HCV genotype 1, absolute differences in sustained virologic response rates between 48 and 24 weeks of treatment were 11.2% (95% CI, 3.6% to 18.9%) and 11.9% (CI, 4.7% to 18.9%), respectively, between standard- and low-dose ribavirin. Sustained virologic response rates for peginterferon-alpha2a and standard-dose ribavirin for 48 weeks were 63% (CI, 59% to 68%) overall and 52% (CI, 46% to 58%) in patients with HCV genotype 1. In patients with HCV genotypes 2 or 3, the sustained virologic response rates in the 4 treatment groups were not statistically significantly different. Treatment with peginterferon-alpha2a and ribavirin may be individualized by genotype. Patients with HCV genotype 1 require treatment for 48 weeks and a standard dose of ribavirin; those with HCV genotypes 2 or 3 seem to be adequately treated with a low dose of ribavirin for 24 weeks.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 March 2016
                2016
                : 11
                : 3
                : e0150569
                Affiliations
                [1 ]Centre de Recherche sur l’Inflammation (CRI), UMR 1149 Inserm, Université Paris Diderot, Service d’Hépatologie, AP-HP Hôpital Beaujon, Paris, France
                [2 ]Department of Gastroenterology, St Vincent’s Hospital, University of Melbourne, Melbourne, VIC, Australia
                [3 ]Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15–540, Białystok, Poland
                [4 ]UCM Digestive Diseases and CIBERehd, Valme University Hospital, University of Seville, Seville, Spain
                [5 ]Biostatistics, PROMETRIS GmbH, 68219, Mannheim, Germany
                [6 ]Global Product Development Medical Affairs, F. Hoffmann-La Roche Ltd, 4074, Basel, Switzerland
                [7 ]Liver Institute of Virginia, Bon Secours Health System, Richmond and Newport News, Richmond, VA, United States of America
                National Taiwan University Hospital, TAIWAN
                Author notes

                Competing Interests: These studies were funded by F. Hoffmann-La Roche Ltd. T Asselah: speaker/consultant: Roche, Boehringer-Ingelheim, AbbVie, Achillion, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck. AJ Thompson: support by an NHMRC fellowship (1053344); consultant to Abbvie, Bristol-Myers Squibb, Gilead Sciences, Merck, Roche Diagnostics, Spring Bank Pharmaceuticals, Arrowhead; research support from Abbvie, Gilead Sciences, Merck; speaker for Abbvie, Bristol-Myers Squibb, Gilead Sciences and Merck. R Flisiak: a speaker and advisor to AbbVie, Bristol-Myers Squibb, Gilead, Janssen, Merck, Novartis, Roche. M Romero-Gomez: consulting fees from AbbVie, Bristol-Myers Squibb, Gilead, Janssen, Merck, Roche Farma, Ferrer, Boeringher Ingelgheim and Novartis; grant support from Roche, Merck and Gilead; and speaker fees from AbbVie, Gilead, Janssen, Merck, Roche Farma, Boeringher Ingelgheim, GSK. Diethelm Messinger is employed by PROMETRIS GmbH. PROMETRIS GmbH has a contract with F. Hoffmann La-Roche Ltd to provide statistical support. G Bakalos is employed by F. Hoffmann-La Roche Ltd. ML Shiffman: consulting fees from AbbVie, Achillion, Bristol-Myers Squibb, Gilead, Janssen, Merck, Roche/Genentech and Vertex; grant support from AbbVie, Achillion, Beckman-Colter, Bristol-Myers Squibb, Boehringer Ingelheim, Conatus, Gilead, Hologic, Intercept, Lumena and Novartis; and speaker fees from AbbVie, Bayer, Gilead, Janssen, Merck, Roche/Genentech and Vertex. Peginterferon alfa-2a (PEGASYS®) and ribavirin (COPEGUS®) are both products marketed by F. Hoffmann-La Roche, Basel, Switzerland and protected by various intellectual property rights. There are no other patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

                Conceived and designed the experiments: TA MRG DM GB. Performed the experiments: RF DM. Analyzed the data: TA RF DM GB. Wrote the paper: TA AJT RF MRG DM GB MLS.

                Article
                PONE-D-15-40146
                10.1371/journal.pone.0150569
                4798721
                26991780
                e18b8177-2226-466f-a908-babc9d041faa
                © 2016 Asselah et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 September 2015
                : 14 February 2016
                Page count
                Figures: 12, Tables: 2, Pages: 20
                Funding
                These studies were funded by F. Hoffmann-La Roche Ltd. F. Hoffmann-La Roche participated in the design and conduct of the study, in the analysis and interpretation of the data, and in the preparation and review of the manuscript before submission. Third-party medical writing assistance, provided by Blair Jarvis MSc, ELS, of Health Interactions, but not editorial content development sufficient to meet International Committee of Medical Journal Editors (ICMJE) authorship criteria, was provided by Health Interactions and funded by F. Hoffmann-La Roche Ltd. F. Hoffmann-La Roche Ltd provided support in the form of salaries for authors [GB]. PROMETRIS GmbH is the clinical research organization contracted by F. Hoffmann-La Roche Ltd to provide data management and statistical services. PROMETRIS GmbH provided support in the form of salaries for authors [DM], participated in the design and conduct of the study, in the analysis and interpretation of the data, and in the preparation and review of the manuscript before submission. The specific roles of these authors are articulated in the ‘author contributions’ section.
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