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7/27/2019 Presentasi Jurnal Doc Arif

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Introduction

Hepatitis C is a significant publichealth concern that affects ~4million Americans. It can progress to

severe liver disease, includingcirrhosis, liver failure, and hepatoma.Hepatitis C virus (HCV) is the

most common cause ofchronic hepatitis in this countryand is the most common

indication for liver

transplantation.


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The incidence of newly diagnosedHCV infection is ~35,000 cases per

year. This represents a significantdecrease,compared with the incidence in

the 1980s (~180,000 cases peryear). The decline in theprevalence of HCV infection overthe past decade is largely due to

the decrease in transmission viablood transfusion that has

resulted from the screening of

blood donors.


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AbstractTreatment guidelines recommend the useof peginterferon alfa-2b or peginterferonalfa-2a in combination with ribavirin forchronic hepatitis C virus (HCV) infection.However, these regimens have not beenadequately compared.

This article discuss the study of :

- sustained virologic response

- safety and adverse- event profiles


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Between :Standard

dosepeginterfero

n alfa-2bregimen

low dose

peginterferonalfa-2b

regimen

Peginterfero

n alfa-2aregimen


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Methods

3 treatments groups :

- Peginterferon alfa-2b standard dose

(1,5g/kgBB/week) + ribavirin

- Peginterferon alfa-2b low dose( 1,0g/kgBB/week) + ribavirin

- Peginterferon alfa-2a (180 g/week) +

ribavirin*oral ribavirin = 1000-1200 mg/day


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Patients criteria :

over 18 years old

hasdetectable HVC RNA level

has not been previously treated forhepatitis

C infection

not having coinfection with HIV

not having severe depression @ severe

psychiatric disorder


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Efficacy assessment

Measure HCV RNA levels using CobasTaqman assay (Roche),which has lowerlimit of quantitation of 27 IU permililiter.

Measurements obtained during atweeks 2,4,12,24 and 48.

Considered failure if:

- insufficient virologic response atweek 12 @ 24. Therapy is discontinued.


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Results

The rates of sustained virologicresponse did not differ significantlyamong the 3 treatment groups :


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Discussion

The safety and adverse-eventprofiles and the efficacy data issimilar among patients with threedifferent regime.

Since monotherapy with standarddose peginterferon alfa-2b has beenassociated with higher rates ofvirologic response duringtreatment,these similar finding isunexpected.


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Sustained virological response was lessfrequent among blacks and those with highbaseline HCV RNA level.

The magnitude of HCV RNA levelsuppression during the treatment phase islinked to sustained virologic response.

Virologic response during week 4 is animportant predictor of sustained virologicresponse:

- among 10% pts. who has undetectableHCV RNA level,86% had a sustainedvirological response


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The time to the 1st undetectable HCV

RNA level was associated with theprobability of virologic relapse afterthe end of treatment:

- 50% patients who had HCV

suppresion for the 1st time by treatmentweek 24 also had virologic relapse ascompared with less than 10% at

treatment week 4.


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Limitations :

Initial doses varied among patients Procedure for for ribavirin-dose

reduction differed between each

regimen group. Study is conducted in

US,comparative data may not

generelizable to other regions.


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Literature review


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Conclusion

Hepatitis C virus transmitted mainly via injectionof drug use (60%).

Hepatitis C chronic is treated with Peginterferonalfa combined with ribavirin to get a better result.

The outcomes of treatment

using both peginterferon alfa-2a

and 2b is similar.


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