WIN-R Is Winning as New Protocol for Hepatitis C

Several recent studies from Europe and the United States confirm that tailoring the dosage and duration of pegylated interferon alfa 2b and ribavirin therapy can optimize treatment of hepatitis C virus (HCV) infection.

NORWEGIAN STUDY RESULTS

Investigators from the Ulleval University Hospital in Oslo demonstrated that the duration of WIN-R therapy (consisting of pegylated interferon alfa 2b, 1.5 µg/kg/wk, plus ribavirin, 800 to 1400 mg/d) may be shortened from 24 to 14 weeks in patients with infection caused by HCV types 2 and 3 who display a rapid virological response.¹ Although the percentage of patients who achieved a sustained virological response (SVR) was higher (93.2%) in the group assigned to the longer treatment course, a substantial percentage of patients (86.3%) assigned to the shorter treatment course also achieved an SVR. The study authors thus concluded that a 14-week course of WIN-R therapy might be clinically feasible.

ITALIAN STUDY RESULTS

A team from the Istituto di Ricovero e Cura a Carattere Scientifico in San Giovanni Rotondo, Italy, reported that therapeutic response was optimized in patients with HCV genotype 1 infection who were treated with WIN-R for a duration established by the time it took for HCV RNA levels to become undetectable.² The team compared outcomes in patients administered either WIN-R (pegylated interferon alfa 2b, 1.5 µg/kg/wk, plus ribavirin, 1000 to 1200 mg/d) or fixed-dosage pegylated interferon alfa 2a (180 µg/wk) plus weight-based ribavirin (1000 to 1200 mg/d) for 48 weeks (standard duration schedule) or 24, 48, or 72 weeks (variable duration schedule). The treatment duration for those patients assigned to a variable schedule was determined by whether HCV RNA was detectable at week 4, 8, or 12, corresponding with the need to treat for 24, 48, or 72 weeks, respectively. SVR in relation to variable treatment duration was 77.2%, 71.9%, and 63.5%, respectively, in patients receiving WIN-R and 87.1%, 70.3%, and 38.1%, respectively, in patients receiving fixed-dosage pegylated interferon alfa 2a.

US STUDY RESULTS

Jacobson and colleagues³ from Cornell University in New York demonstrated that WIN-R therapy is superior to therapeutic regimens consisting of weight-based dosing for pegylated interferon alfa 2b plus a fixed dosage (800 mg/d) of ribavirin, particularly in patients infected with the HCV genotype 1. In another study, they also showed that in African American patients with HCV genotype 1 infection, WIN-R therapy has an advantage over regimens in which the ribavirin dosage is fixed.⁴ (Genotype 1 predominates and SVR rates typically are low in affected African Americans.) The researchers found that SVR rates were higher in African American patients who received WIN-R therapy than in those who received a regimen with a fixed dosage of ribavirin (21% vs 10%). In addition, relapse rates were lower (22% vs 30%).

References:

REFERENCES:

1.

Dalgard O, Bjøro K, Ring-Larsen H, et al. Pegylated interferon alfa and ribavirin for 14 versus 24 weeks in patients with hepatitis C virus genotype 2 or 3 and rapid virological response.

Hepatology.

2008;47:35-42.

2.

Mangia A, Minerva N, Bacca D, et al. Individualized treatment duration for hepatitis C genotype 1 patients: a randomized controlled trial.

Hepatology.

2008;47:43-50.

3.

Jacobson IM, Brown RS Jr, Freilich B, et al. Peginterferon alfa-2b and weight-based or flat-dose ribavirin in chronic hepatitis C patients: a randomized trial.

Hepatology.

2007;46: 971-981.

4.

Jacobson IM, Brown RS Jr, McCone J, et al. Impact of weight-based ribavirin with peginterferon alfa-2b in African Americans with hepatitis C virus genotype 1.

Hepatology.

2007;46:982-990.