DOI: 10.1097/MEG.0b013e328342af3d

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PMID: 21228684

Issn Print: 0954-691X

Publication Date: 2011/02/01


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Treatment of chronic hepatitis C with pegylated interferon and ribavirin in treatment-naive patients in ‘true life’

Ezequiel Ridruejo

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Excerpt

I have read with interest the article by Pariente et al. [1] published in a recent issue of European Journal of Gastroenterology & Hepatology. The researchers reported an overall sustained viral response (SVR) rate of 50% in patients with HCV treated with pegylated interferon and ribavirin (37.1, 70.5, and 71% for patients with genotype 1, 2, and 3, respectively); and 14% discontinuation rate because of side-effects. They showed that SVR rate in this French population is lower than the rates of the randomized controlled trials (RCTs).
We have reported the results in our patients who were also treated in ‘true life’: 7.6% of patients discontinued therapy because of adverse events, and 1.2% of patients dropped out of treatment. The overall SVR was 60.8% (51.8, 80.3, and 69% for patients with genotypes 1, 2, and 3, respectively) [2]. These results are similar to those reported by European and North American studies in daily clinical practice [3–6], and higher than those reported by Pariente et al. [1].
This study adds information to the debate of SVR rates of HCV treatment in real life. RCT results may not reflect the results in routine clinical practice, and studies carried out in ‘true life’ are needed to confirm these conclusions. In clinical practice we treat ‘real patients’ and cannot select the best candidates for treatment, as in RCT. Our study shows that obtaining high rates of treatment completion (through strict adherence and adequate management of adverse events) results in high SVR rates in routine clinical care. It should be emphasized that treatment by experienced physicians in routine clinical practice, is safe and effective. Adequate selection of candidates for treatment is very important to obtain substantial SVR rates.
Genetic variations might be responsible for the differences in SVR rates in these studies [7,8]. Perhaps, a meta-analysis can help us to establish which real SVR is present in ‘true life’.

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