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Equally Poor Outcomes to Pegylated Interferon-based Therapy in African Americans and Hispanics With Chronic Hepatitis C Infection

Satapathy, Sanjaya K. MD, DM* †; Lingisetty, Chandra Sekhar MD*; Proper, Shawnette RPA-C; Chaudhari, Shobhana MD, FACP*; Williams, Susan MD

Journal of Clinical Gastroenterology: February 2010 - Volume 44 - Issue 2 - p 140-145
doi: 10.1097/MCG.0b013e3181ba9992
LIVER, PANCREAS AND BILIARY TRACT: Original Articles
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Objectives Treatment response to pegylated interferon based regimen is different between African Americans and Whites, but little comparable data is available comparing Hispanics and African Americans.

Patients We retrospectively evaluated the rate of success in the treatment completion and response to peginterferon α-2a or α-2b plus ribavirin in 103 (male:female-69:34) hepatitis C virus (HCV)-polymerase chain reaction positive patients that included 68 Hispanic and 35 African Americans.

Methods Patients were treated with peginterferon α-2a 180 mcg/wk (n=25) or peginterferon α-2b 1.5 mcg/kg/wk (N=78) and ribavirin 1000 to 1200 mg/d for 24 weeks (genotype 2 and 3) or 48 weeks (genotype 1 and 4) based on the genotype of the patient. Treatment was discontinued if the patients failed to have a 2-log drop in viral load after 12 weeks of treatment. Primary aim of the study was to evaluate success in completing a scheduled duration of pegylated interferon and ribavirin treatment in patients with chronic HCV infection and the reasons for discontinuation of the treatment. The secondary aim was to look for the end of treatment virologic response and sustained virologic response. The analysis was conducted by intention-to-treat.

Results Of the 103 patients included in the study, 50 (48.5%) patients dropped out of the treatment because of side effects of the drug or noncompliance to the treatment protocol or alternate reasons; 44 (42.7%) of them could not continue beyond 12 weeks of therapy. There were no significant differences in the drop out rate between the African American [15 (43%)] and Hispanic [35 (51.5%)] patients (P=0.41). Overall, 41% of the patients completed the scheduled 24 week or 48 week treatment. HCV genotype-1 was the most prevalent genotype in both African Americans and Hispanics (88.6% vs. 75%, P=0.10). Overall end of the treatment response (ETR) was 29.1% (30/103) and sustained virologic response (SVR) was 23.3% (24/103) in this population. No significant differences were noted in the ETR (20% vs. 34%, P=0.14) and the SVR (20% vs. 25%, P=0.57) between the African Americans and Hispanics. When data were analyzed by genotype, overall SVR rates were 14.6% (12/82) in genotype 1 versus 57% (12/21) in genotype 2/3/4 (P<0.0001). Both these ethnic groups had comparable response rates when only patients with genotype-1 were considered 5/31 (16.1%) versus 7/51 (13.7%, P=0.76).

Conclusions A significant proportion of the African Americans and Hispanics referred for HCV treatment with pegylated interferon dropped out early in the therapy, suggesting possible racial, socioeconomic, and cultural barriers in successful treatment for chronic HCV infection. Overall, both groups had similar poor response rates, well below those reported for White patients. As is true for the general population, patients with nongenotype 1 infection had a significantly better ETR and SVR.

Departments of *Internal Medicine

Gastroenterology, New York Medical College/Metropolitan Hospital Center

Department of Internal Medicine, New York Medical College/Metropolitan Hospital Center, New York, NY

Author's disclosure: All authors confirm that they have no competing interest and no financial disclosure to make. No grants of financial support were used in the preparation of this manuscript.

Reprints: Susan Williams, MD, Gastroenterologist, Department of Gastroenterology, New York Medical College/Metropolitan Hospital Center, 1901 First Avenue, New York, NY 10029 (e-mail: susan.williams@nychhc.org).

Received for publication February 8, 2009; accepted August 4, 2009

© 2010 Lippincott Williams & Wilkins, Inc.