Enhanced efficacy of pegylated interferon alpha-2a over pegylated interferon and ribavirin in chronic hepatitis C genotype 4A randomized trial and quality of life analysis

Aim The therapy of chronic hepatitis C genotype 4 (HCV-4) has not been optimized yet. This randomized, prospective, parallel-group clinical trial compared the efficacy and safety of pegylated interferon alpha-2a (PEG-IFN alpha-2a) plus ribavirin and PEG-IFN alpha-2b plus ribavirin and assessed the health-related quality of life (HRQOL) in patients with chronic HCV-4. Methods Eligible patients with proven chronic HCV-4 were randomized to receive either a weekly dose of PEG-IFN alpha-2a (180 mu g) or PEG-IFN alpha-2b (1.5 mu g/kg) and a daily dose of ribavirin (1000-1200 mg) for 48 weeks with 24 weeks post-treatment follow-up. The primary end point was sustained virological response (SVR) defined by undetectable HCV RNA 24 weeks after treatment. The Short form-36 Health Survey version 2 (SF-36v2) and the Chronic Liver Disease questionnaires (CLDQ) were assessed before, during and after therapy. Results The overall SVR rate of the entire cohort was 59.9%. The SVR rates were significantly higher in patients treated with PEG-IFN alpha-2a and ribavirin (Group A; n=109) compared with those treated with PEG-IFN alpha-2b and ribavirin (Group B; n=108, 70.6 vs. 54.6%, respectively; P=0.017). The relapse rates were 5.1% for PEG-IFN alpha-2a and 15.7% for PEG-IFN alpha-2b (P=0.0019). The SF-36v2 and CLDQ were low during therapy and improved significantly after therapy successful therapy. Conclusion Pegylated interferon alpha-2a plus ribavirin was significantly more effective than PEG-IFN alpha-2b and ribavirin therapy in the treatment of chronic HCV-4 patients. The tolerability and adverse events were comparable between the two regimens. The HRQOL improved significantly after successful PEG-IFN alpha-2a plus ribavirin therapy.