Efficacy of Pegylated Interferon and Ribavirin for the Treatment of Chronic Hepatitis C, Genotype 3 Patients in Thailand
Watcharasak Chotiyaputta MD1, Uayporn Kaosombatwattana MD1, Naichaya Chamroonkul MD2, Chalermrat Bunchorntavakul MD3, Kitisak Seansawat MD4, Karjpong Techathuvanan MD5, Pisit Apisophonsiri MD6, Tawesak Tanwandee MD1
Affiliation : 1 Division of Gastroenterology, Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Division of Gastroenterology, Department of Internal Medicine, Prince of Songkla University, Thailand 3 Division of Gastroenterology, Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand 4 Division of Gastroenterology, Department of Medicine, Somdech Phra Pinklao Hospital, Thailand 5 Division of Gastroenterology, Department of Medicine, Vajira Hospital, Thailand 6 Division of Gastroenterology, Department of Medicine, Klang Hospital, Thailand
Objective : Direct-acting antivirals [DAAs] arecurrently widely used for treatment of patients with chronic hepatitis C
[CHC]. Few patients are able to access these regimens, especiallyin developing countries. Pegylated interferon [peg-IFN]
and ribavirin [RBV] treatment is, therefore, still important. Since 2012, the Thai government has declared peg-IFN and RBV
treatment is the standard of care for Thai patients with CHC. The aims of this study were to evaluate the effectiveness of
peg-IFN and RBV treatment in CHC, genotype 3 patients in a real-world setting and to determine factors indicating favorable
response.
Materials and Methods : This was a retrospective chart review. The data were collected from 30 hospitals in Bangkok and 14
hospitals in Northeastern Thailand during 2012 to 2014. The inclusion criteria were age 18 to 65 years, baseline hepatitis C
virus [HCV] viral load [VL] >5,000 IU/mL, naive to treatment, and at least moderate fibrosis before treatment. Patients with
HIV or hepatitis B virus [HBV] co-infection or decompensated cirrhosis were excluded. All patients were treated with peg-
IFN and RBV for 24 weeks.
Results : A total of 523 patients were enrolled. The mean age was 48.7+8.6 years, and 51.6% of patients had age above 50
years. Fifty-two percent were male, and the mean body mass index [BMI] was 24.5+3.7 kg/m2. Fifty-eight percent of
patients had cirrhosis at baseline. Mean HCV VL was 5.8+0.8 log10 IU/mL, and 62.1% had HCV VL above 5.6 log10 IU/mL.
The mean alanine aminotransferase [ALT] level at baseline was 106.8+66.5 U/L, and the mean platelet count was
158,000+65,900/mm3. The overall prevalence of sustained virological response [SVR] was 74.6%. The prevalences of SVR
in patients with cirrhosis and without cirrhosis were 66.8% and 84%, respectively (p<0.001). Factors determining good
response were noncirrhosis, HCV VL <5.6 log10 IU/mL at baseline, age <50 years, no reduced dose of peg-IFN during
treatment, and platelet count >150,000/mm3. Multivariate analysis, however, demonstrated that factors indicating favorable
response were age <50 years, no cirrhosis, and HCV <5.6 log10 IU/mL at baseline.
Conclusion : The effectiveness of peg-IFN and RBV for treatment of patients with CHC, genotype 3 was good. Patients
with old age, cirrhosis, and high HCV VL at baselinetended to have treatment failure. DAAsmay be considered as the first
treatment for patients with these factors.
Keywords : Hepatitis C, Real-world, Interferon, Ribavirin, Genotype 3
