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‘Easy to treat’ genotypes were not created equal: Can rapid virological response (RVR) level the playing field?  Andres Duarte-Rojo, Elizabeth Jenny Heathcote,

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Presentation on theme: "‘Easy to treat’ genotypes were not created equal: Can rapid virological response (RVR) level the playing field?  Andres Duarte-Rojo, Elizabeth Jenny Heathcote,"— Presentation transcript:

1 ‘Easy to treat’ genotypes were not created equal: Can rapid virological response (RVR) level the playing field?  Andres Duarte-Rojo, Elizabeth Jenny Heathcote, Jordan Jay Feld  Journal of Hepatology  Volume 55, Issue 2, Pages (August 2011) DOI: /j.jhep Copyright © 2011 European Association for the Study of the Liver Terms and Conditions

2 Fig. 1 Factors associated with response to treatment in chronic hepatitis C infection. Genetic factors such as IL28B genotype and hepatic gene expression profiles are important host determinants of response. Metabolic factors such as obesity, steatosis, insulin resistance, and type 2 diabetes mellitus also play an important role. Journal of Hepatology  , DOI: ( /j.jhep ) Copyright © 2011 European Association for the Study of the Liver Terms and Conditions

3 Fig. 2 Bar chart showing the sustained virological response rates in the ACCELERATE (Shiffman et al.) and NORDynamIC (Lagging et al.) trials, which focused on patients with G2/G3 infection. The results are shown according to genotype and duration of treatment ∗p value <0.01. Journal of Hepatology  , DOI: ( /j.jhep ) Copyright © 2011 European Association for the Study of the Liver Terms and Conditions

4 Fig. 3 The sustained virological response rates (SVR) obtained in randomized controlled trials (Mangia et al. and Dalgard et al.) comparing 24-week and short courses of pegIFN and RBV according to rapid virological response (RVR) are shown. The colored bars show the response rates in patients who achieved RVR. The different colors show the different genotypes and the duration of therapy, short vs standard 24weeks. The white bars at the bottom show the rates of SVR in those who did not achieve RVR. The results are divided by genotype but notably, all non-RVR patients were treated for 24weeks. The results from the ACCELERATE trial (Shiffman et al.), in which treatment duration was not dependent on RVR, are depicted in the same way for comparison. Journal of Hepatology  , DOI: ( /j.jhep ) Copyright © 2011 European Association for the Study of the Liver Terms and Conditions

5 Fig. 4 Results from the pegIFN-α2a registration trial (Hadziyannis et al.) demonstrating the lack of difference in sustained virological response (SVR) according to length of therapy (between 24-week and 48-week) and RBV dose (standard vs weight-based), in genotype 2 and genotype 3 patients. Reanalysis of the same data from Willems et al. demonstrates the superior SVR rate from the extended/intensive regimen (48-week and weight-based RBV) in those who failed to achieve a rapid virological response. Journal of Hepatology  , DOI: ( /j.jhep ) Copyright © 2011 European Association for the Study of the Liver Terms and Conditions

6 Fig. 5 Algorithm for addressing length of therapy in genotype 2 (G2) and genotype 3 (G3) infection, according to rapid virological response (RVR). Broken arrows show proposed strategies drawn from available evidence, but for which randomized clinical trials are lacking or currently ongoing. Whether the presence of IR/steatosis should be considered within these negative parameters remains in question. In patients without an RVR it is likely that extending therapy to 48weeks may increase the rate of sustained virological response, and trials are ongoing. This may be especially true for patients with unfavorable IL28B genotypes (CT and especially TT variants). BMI, body mass index; F, fibrosis; VL, viral load; IR, insulin resistance. Journal of Hepatology  , DOI: ( /j.jhep ) Copyright © 2011 European Association for the Study of the Liver Terms and Conditions

7 Journal of Hepatology 2011 55, 466-473DOI: (10. 1016/j. jhep. 2011. 02
Copyright © 2011 European Association for the Study of the Liver Terms and Conditions


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