Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals
European Journal of Clinical and Biomedical Sciences
Volume 5, Issue 3, June 2019, Pages: 51-57
Received: Jul. 12, 2019;
Accepted: Aug. 20, 2019;
Published: Sep. 9, 2019
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Halina Michur, Institute of Liver Studies, King’s College Hospital, London, UK
Phillip Morgan, Institute of Liver Studies, King’s College Hospital, London, UK
Ivana Carey, Institute of Liver Studies, King’s College Hospital, London, UK
Nigel Brown, Department of Clinical Chemistry, Wansbeck General Hospital, Ashington, UK
Nigel Heaton, Institute of Liver Studies, King’s College Hospital, London, UK
Michael Heneghan, Institute of Liver Studies, King’s College Hospital, London, UK
Kosh Agarwal, Institute of Liver Studies, King’s College Hospital, London, UK
John Michael Tredger, Institute of Liver Studies, King’s College Hospital, London, UK
In treating hepatitis C infection, identification of reliable markers predicting virological non-response appear central to improving outcome and to prompting changes in dynamic treatment approaches. The interrelationship of ribavirin (RBV) concentrations and laboratory variables with clinical outcomes was evaluated in HCV patients treated with ribavirin, and with or without early direct acting antivirals (DAA). Correlations between RBV concentration, laboratory variables (haemoglobin, absolute lymphocyte, platelet and neutrophil counts, serum creatinine and hepatitis C viral load) and patients’ characteristics associated with sustained virological response (SVR) were investigated using multivariate analysis. The 76 patients studied all received interferon (INF) and RBV, with 37 additionally given Boceprevir or Telaprevir. Significant correlations were noted between week 1 RBV concentration and subsequent total exposure at weeks 2, 4 and 12 (P < 0.0001). RBV concentrations in excess of 1.0 mg/L (week 1) and 2.0 mg/L (week 2) provided targets for avoiding breakthrough (P < 0.05). SVR was greater in patients without cirrhosis (73.3% vs. 41.3%; P < 0.01). All patients with an absolute haemoglobin (Hb) fall >30 g/L (week 8) experienced higher SVR rates (P < 0.03). RBV concentrations above 2.7 mg/L at week 4 or later increased the likelihood of Hb falls >30 g/L. Six factors were predictive of SVR in univariate analysis, and three in multivariate analysis. There is an association between SVR and absolute lymphocyte count, IL-28B CC genotype, and HCV-RNA load fall at week 1 (>80 %) or week 2 (>90 %) in HCV patients treated with INF/RBV and early DAA.
John Michael Tredger,
Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals, European Journal of Clinical and Biomedical Sciences.
Vol. 5, No. 3,
2019, pp. 51-57.
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