Identification of naive HCV-1 patients with chronic hepatitis who may benefit from dual therapy with peg-interferon and ribavirin

Aim. The pool of HCV genotype 1 patients likely to be cured by peg-interferon and ribavirin remains to be quantified. Methods. In 1045 patients treated with peg-interferon and ribavirin, two therapeutic strategies were confronted: the first one evaluated only baseline variables associated with sustained virological response (SVR), and the second one included the rapid virological response (RVR). Attaining a >80% SVR was the threshold rate to retain a strategy as clinically relevant. Results: Overall, 414 patients (39%) attained SVR. In the first strategy, the hierarchy of independent predictors of SVR were IL28B CC genotype (OR 4.953; CI 3.560-6.890), low (<400.000 IU) viremia (OR 2.756; CI 2.018-3.765), F0-F2 fibrosis (OR 1.484; CI 1.050-2.097) and age < 50 years (OR 1.385; CI 1.015-1.891). In the alternative strategy, SVR predictors were RVR (OR 6.773; CI 4.640–9.887), IL28B CC genotype (OR 3.363; CI 2.351–4.810) and low viremia (OR 2.071; CI 1.477-2.903). By combining the first three favorable baseline variables, the probability of SVR ranged from 42.4% to 82.9%, but only 65 patients (5.4%, overall) with all predictors could be anticipated to reach the >80% SVR threshold. Only 25.1% of no-RVR patients attained SVR. For 287 RVR patients, the likelihood of SVR was 66.7% in those with unfavorable predictors, >80% in the presence of a single predictor, and 100% when both predictors were present. By using this model, 200 patients (19.1%) were predicted to have a >80% chance of being cured with dual therapy. Conclusion: A consistent subset of naïve HCV-1 patients, identified by their interferon responsiveness and some baseline predictors , may benefit from conventional treatment with peg-interferon and ribavirin.