Randomized trial of peginterferon alfa‐2b and ribavirin for 48 or 72 weeks in patients with hepatitis C virus genotype 1 and slow virologic response

The benefit of extending treatment duration with peginterferon (PEG‐IFN) and ribavirin (RBV) from 48 weeks to 72 weeks for patients with chronic hepatitis C genotype 1 infection has not been well established. In this prospective, international, open‐label, randomized, multicenter study, 1,428 treatment‐naïve patients from 133 centers were treated with PEG‐IFN alfa‐2b (1.5 μg/kg/week) plus RBV (800‐1,400 mg/day). Patients with detectable hepatitis C virus (HCV) RNA and a ≥2‐log 10 drop in HCV RNA levels at week 12 (slow responders) were randomized 1:1 to receive 48 weeks (n = 86) or 72 weeks (n = 73) of treatment. Sustained virologic response (SVR) rates were 43% in slow responders treated for 48 weeks and 48% in slow responders treated for 72 weeks ( P = 0.644). Relapse rates were similar in slow responders treated for 48 or 72 weeks (47% versus 33%, P = 0.169). The safety profile was similar in both treatment arms; serious adverse events leading to discontinuation of treatment were observed in 3.5% of slow responders treated for 48 weeks and 8.2% of those treated for 72 weeks. Among slow responders with a <2‐log drop in HCV RNA at week 8, SVR was 39% in the 72‐week arm and 19% in the 48‐week arm. Conclusion: These data suggest that 48 weeks of therapy with PEG‐IFN alfa‐2b plus RBV (800‐1,400 mg/day) should remain a standard‐of‐care treatment for treatment‐naïve G1 slow responders. (Hepatology 2010)