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DOI: 10.1055/s-0032-1324001
Thyroid dysfunction induced by peginterferon alfa-2b (Peg-2b)/Ribavirin (RBV) is a favorable predictor of SVR in difficult-to-treat patients with HCV Genotype 1 (G1) infection
Aims: Thyroiditis leading to thyroid dysfunction in up to 15% of pts treated for chronic HCV infection has been attributed to interferon-stimulated immune mechanisms similar to that in antiviral response induced by interferons. We analyzed the possible association between thyroid dysfunction related to Peg2b/RBV and the virologic outcome of pts treated for HCV G1 infection.
Methods: Data from 1923 pts treated for G1 infection with Peg2b 1.5µg/kg/wk+weight-based RBV 800–1200mg/day for up to 48 wks in an observational real-life study at 285 sites in Germany were retrospectively analyzed. Thyroid dysfunction was estimated by serum TSH levels. Pts who discontinued for non-response or for any other reasons were included in the analysis.
Results: 1436 pts had normal TSH levels at baseline and at least one TSH measurement during therapy. After starting treatment abnormal TSH values became apparent in 304 pts (21.2%). Compared to pts with normal TSH values significantly higher SVR rates were achieved by pts with abnormal TSH values. This favorable effect was more pronounced in „difficult-to-treat” pts with high baseline viral load (HVL) and age older than 50yrs and was associated with a significant reduction of virologic non-response. Similar and significant reductions of non-response rates were observed in pts with abnormal TSH values and low platelet count <150 n/L indicative for advanced fibrosis. Interestingly, SVR rate was not improved in this subgroup, but there was a shift from virologic non-response to relapse indicated by an increase of relapse rates from 31.1% to 45.0% in pts with normal/abnormal TSH values and low platelet count. Multivariate logistic regression analysis including gender, viral load, age and platelet count identified abnormal TSH as independent factor associated with SVR (OR=1.4; p=0.0124).
normal TSH |
abnormal TSH |
P |
|
SVR, % (n/N) |
|||
overall |
44.0 (498/1132) |
53.6 (163/304) |
0.0028 |
age <50 years |
48.1 (361/750) |
54.2 (117/216) |
0.1181 |
age >50 years |
35.9 (137/382) |
52.3 (46/88) |
0.0044 |
LVL <600.000 IU/ml |
56.4 (286/507) |
58.7 (84/143) |
0.6191 |
HVL >600.000 IU/ml |
33.6 (200/596) |
49.0 (77/157) |
0.0003 |
nonresponse, % (n/N) |
|||
overall |
34.9 (395/1132) |
24.7 (75/304) |
0.0007 |
age <50 years |
31.2 (234/750) |
22.7 (49/216) |
0.0154 |
age >50 years |
42.1 (161/382) |
29.5 (26/88) |
0.0295 |
LVL <600.000 IU/ml |
24.1 (122/507) |
21.0 (30/143) |
0.4416 |
HVL >600.000 IU/ml |
44.0 (262/596) |
27.4 (43/157) |
0.0002 |
Conclusions: Thyroid dysfunction triggered during Peg2b/RBV treatment of HCV G1 infection is a favorable independent factor predicting high SVR and low non-response rates in difficult-to-treat pts.