Interferon (IFN) Based Treatment of African Americans with Chronic Hepatitis C (CHC) in an Urban Clinic: Improving Response with Advances in Therapy

Abstract

AIM: In this paper, we review the results of the addition of a direct acting antiviral (DAA) to dual therapy [Pegylated-Interferon (Peg-IFN)+Ribavirin (Riba)] therapy in African Americans (AA) treated for chronic hepatitis C (CHC) in an urban GI clinic as compared to the licensing studies. METHODS: Patients with genotype one (G1) CHC treated with dual therapy (n=341 naïve patients), were compared to G1 patients (n=75 naïve or previously treated with interferon based therapy) treated with triple therapy (telaprevir or boceprevir +Peg-IFN+Riba). Treatment response was assessed for both intent to treat and patients completing at least 12 weeks of therapy (protocol). RESULTS: The sustained viral response (SVR) for all patients completing treatment and the follow up period was significantly higher with triple therapy as compared to dual therapy (AA: 51% vs 24%; Cau 100% vs 36%). In interferon experienced patients, the SVR for triple therapy was better in patients who had relapsed as compared to non-responders or naïve patients. The response rate with triple therapy was also better across all stages of fibrosis. Despite the increase in side effects seen in patients with the addition of DAA, discontinuation rates were fewer for triple than for dual therapy. CONCLUSIONS: The data confirms previous reports from the licensing trials that adding a 1st generation DAA to dual therapy in the real world clinic setting provides a significant improvement in SVR in African Americans, regardless of whether the patients are naïve or treatment experienced. While treatment with these therapies are clearly beneficial for patients with advanced disease, the lower SVR rate for AA as compared to Cau presents a challenging situation and that waiting for more effective therapies may be a prudent option for the majority of patients.