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• W2029404414 abstract "Recently, we have shown that the use of a decision analysis model could be helpful in therapeutic decision for patients with HCV-1b infection.1Moriguchi H Uemura T Kobayashi M Chung RT Sato C. Management strategies using pharmacogenomics in patients with severe HCV-1b infection: a decision analysis.Hepatology. 2002; 36: 177-185Crossref PubMed Scopus (12) Google Scholar In that study, we were unable to show the optimal management strategies for the combination therapy with pegylated interferon (IFN) alfa-2b and ribavirin, since data for the combination therapy had not been available. Therefore, we read with interest the recent article by Poynard et al., reporting the efficacy of the combination therapy on liver fibrosis in the patients with chronic hepatitis C.2Poynard T McHutchison J Manns M Trepo C Lindsay K Goodman Z Ling M Albrecht J. Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C.Gastoroenterology. 2002; 122: 1303-1313Abstract Full Text Full Text PDF PubMed Scopus (1003) Google Scholar For the decision of IFN therapy for severe HCV-1b infection (HCV-1b [F3]), our model have shown that the following 3 factors are critical: (1) QOL scores of HCV-1b (F3) patients aged 40 to 60 years, (2) the transition probability of liver disease when patients are judged as nonresponders (NR) after IFN therapy, and (3) the SVR rate of these patients after IFN therapy. In the recent article by Poynard et al.,2Poynard T McHutchison J Manns M Trepo C Lindsay K Goodman Z Ling M Albrecht J. Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C.Gastoroenterology. 2002; 122: 1303-1313Abstract Full Text Full Text PDF PubMed Scopus (1003) Google Scholar the transition probability of liver disease after the combination therapy with pegylated IFN alfa-2b 1.5 mg/kg per week and ribavirin (48 weeks) was shown to be 12.2% (5.09%-14.1%) per year when patients were judged as NR. Although QOL scores of HCV-1b (F3) patients aged 40 to 60 years in the combination therapy are still unavailable, it is possible to speculate the essential SVR rate to apply the combination therapy to all HCV-1b (F3) patients by age, using our decision analysis model1Moriguchi H Uemura T Kobayashi M Chung RT Sato C. Management strategies using pharmacogenomics in patients with severe HCV-1b infection: a decision analysis.Hepatology. 2002; 36: 177-185Crossref PubMed Scopus (12) Google Scholar and the data by Poynard et al.,2Poynard T McHutchison J Manns M Trepo C Lindsay K Goodman Z Ling M Albrecht J. Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C.Gastoroenterology. 2002; 122: 1303-1313Abstract Full Text Full Text PDF PubMed Scopus (1003) Google Scholar if their QOL scores do not decline in the combination therapy compared with the other IFN therapies.1Moriguchi H Uemura T Kobayashi M Chung RT Sato C. Management strategies using pharmacogenomics in patients with severe HCV-1b infection: a decision analysis.Hepatology. 2002; 36: 177-185Crossref PubMed Scopus (12) Google Scholar, 3Younossi ZM Singer ME McHutchison JG Shermock KM. Cost-effectiveness of interferon alpha-2b combined with ribavirin for the treatment of chronic hepatitis C.Hepatology. 1999; 30: 1318-1324Crossref PubMed Scopus (160) Google Scholar Age, the presence of bridging fibrosis/cirrhosis, HCV genotype, baseline viral load, and baseline weight are shown to be associated with SVR in the combination therapy,4Manns M McHutchison J Gordon S Rustigi V Shiffman M Reindollar R Goodman Z Koury K Ling M Albrecht J. Pegylated interferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial.Lancet. 2001; 358: 958-965Abstract Full Text Full Text PDF PubMed Scopus (5908) Google Scholar and the SVR rate for the patients with HCV-1 (1a or 1b) is highest in the combination therapy.4Manns M McHutchison J Gordon S Rustigi V Shiffman M Reindollar R Goodman Z Koury K Ling M Albrecht J. Pegylated interferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial.Lancet. 2001; 358: 958-965Abstract Full Text Full Text PDF PubMed Scopus (5908) Google Scholar Therefore, we speculated the essential SVR rate to apply the combination therapy to all HCV-1b (F3) patients by age, conducting the 2-way sensitivity analyses by using our decision analysis model1Moriguchi H Uemura T Kobayashi M Chung RT Sato C. Management strategies using pharmacogenomics in patients with severe HCV-1b infection: a decision analysis.Hepatology. 2002; 36: 177-185Crossref PubMed Scopus (12) Google Scholar and the data by Poynard et al.2Poynard T McHutchison J Manns M Trepo C Lindsay K Goodman Z Ling M Albrecht J. Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C.Gastoroenterology. 2002; 122: 1303-1313Abstract Full Text Full Text PDF PubMed Scopus (1003) Google Scholar The essential SVR rate in the combination therapy at 40, 50, and 60 years old was 19% (13.2%-19.6%), 18.9% (12.9%-19.6%), and 19.2% (14.6%-19.9%), respectively. For example, to apply the combination therapy to all HCV-1b (F3) patients at age 40, the overall SVR rate must exceed 19% (13.2%-19.6%) (Figure 1). According to the recent data, the overall SVR rate for HCV-1 (1a or 1b; mean age 43 years old) in the combination therapy was 42%.4Manns M McHutchison J Gordon S Rustigi V Shiffman M Reindollar R Goodman Z Koury K Ling M Albrecht J. Pegylated interferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial.Lancet. 2001; 358: 958-965Abstract Full Text Full Text PDF PubMed Scopus (5908) Google Scholar Therefore, it can be speculated that the combination therapy appears to be the first line of treatment for patients with HCV-1b (F3) at age 40. On the other hand, since the data of the SVR rate in the combination therapy for HCV-1b (F3) patients aged 50 and 60 years are still unavailable, it is unclear whether this therapy is the first line of treatment for this group of patients or not. It would be possible, however, to clarify the picture for this group by using our decision analysis model1Moriguchi H Uemura T Kobayashi M Chung RT Sato C. Management strategies using pharmacogenomics in patients with severe HCV-1b infection: a decision analysis.Hepatology. 2002; 36: 177-185Crossref PubMed Scopus (12) Google Scholar and the data by Poynard et al.2Poynard T McHutchison J Manns M Trepo C Lindsay K Goodman Z Ling M Albrecht J. Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C.Gastoroenterology. 2002; 122: 1303-1313Abstract Full Text Full Text PDF PubMed Scopus (1003) Google Scholar when response data relevant to this age group become available in near future." @default.
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• W2029404414 title "Optimal IFN therapy for 40-year-old patients with severe HCV-1b infection" @default.
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