Introduction Combination therapy for chronic hepatitis C (CHC) achieves sustained viral response (SVR) in randomised trials. We studied factors predicting SVR 6 months after the end of treatment (undetectable viral load by PCR) in normal clinical practice, in a large cohort of CHC patients treated in a single tertiary referral centre in Leeds, UK.
Methods Data for individuals receiving combination therapy for CHC were collected prospectively between February 2001 and May 2008. Age, gender, ethnicity, type of interferon (α-2a or 2b), genotype, presence of cirrhosis, body mass index (BMI), alcohol use (none vs any), serum ferritin, and history of intravenous drug use (IVDU) or psychiatric illness were collected prior to commencing therapy. Early discontinuation of therapy was also recorded. The association between these variables and achieving an SVR was explored by univariate and multivariate analysis, with ORs and 95% CIs. Data from individuals being re-treated for CHC were not analysed. Individuals defaulting follow-up with no SVR data at 6 months were classed as treatment failures.
Results During the study period 394 individuals with CHC commenced combination therapy (257 (65%) male, mean age 42 years (range 21–74)). After univariate analysis SVR at 6 months was significantly more likely in younger patients (OR per year 0.96, 95% CI 0.94 to 0.98), with interferon α-2b (OR 1.61, 95% CI 1.00 to 2.58), in genotype 2 and 3 compared with genotype 1 (OR 3.52, 95% CI 1.47 to 8.44, and OR 3.51, 95% CI 2.23 to 5.54, respectively), and significantly less likely in those with biopsy-proven cirrhosis (OR 0.24, 95% CI 0.15 to 0.39), in those consuming any alcohol (OR 0.35, 95% CI 0.22 to 0.55), those with serum ferritin >250 (OR 0.26, 95% CI 0.15 to 0.46), and those discontinuing therapy early (OR 0.22, 95% CI 0.13 to 0.39). Following multivariate analysis effect of genotype, alcohol use, presence of cirrhosis, and early discontinuation of therapy on SVR remained significant. Gender, ethnicity, BMI, and prior history of IVDU or psychiatric illness had no effect on SVR at 6 months in any of our analyses.
Conclusion Data from this large cohort of patients with CHC treated with combination therapy demonstrate lower SVR rates in those consuming alcohol and those with cirrhosis. The former should be advised to cease consuming alcohol prior to embarking on therapy, and the latter should be warned of the reduced likelihood of successful therapy. A prior history of IVDU or psychiatric illness should not preclude consideration of combination therapy.
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