Page 26 - The Flying Publisher Guide to Hepatitis C Treatment

26 | Hepatitis C Treatment

Table 1.2 – First-line treatment recommendations for antiviral
therapy in Hepatitis C*
HCV PegIFN alfa-2a PegIFN alfa-2b RBV Planned
Genotypes once per week once per week once per day duration†
1 and 4 180 µg 1.5 µg/kg 15 mg/kg weight- 48 weeks
Flat dose weight-based based dose
dose
2 and 3 180 µg 1.5 µg/kg 800 mg daily 24 weeks
Flat dose weight-based flat dose, if BMI<25
dose
15 mg/kg weight-
based dose, if
BMI>25
*According to data from EASLD 2011
†Treatment duration should be tailored to the on-treatment virological response
at weeks 4 and 12, and eventually, week 24.

For RGT, the following recommendations can be made
(Tsubota 2011):
– Treatment duration can be reduced to 12 weeks for
genotypes 2/3 infected patients who obtain an RVR with
PegIFN and weight-based RBV dosing. This does not
compromise the likelihood of achieving an SVR, but reduce
the AEs and the associated costs.
– Treatment duration can be reduced to 24 weeks for
genotype 1 infected patients with low baseline
(pretreatment) VL who attain a RVR.
– Treatment may be extended to 72 weeks for genotype 1
infected patients who show a slow virological response (with
partial EVR and HCV RNA negative by week 24). However,
for those who do not attain an EVR, the chance of treatment
success is very low (Thomson 2008).
In the clinical trials of the new direct-acting antivirals, a new
marker has been implemented, namely extended RVR (Sherman
2010). Extended RVR (eRVR) is defined as undetectable HCV
RNA at week 4 of therapy, maintained through a later time point
(in some cases over a period of 12 weeks, in others over 24
weeks). eRVR is a good predictor of the ability to shorten triple
therapy with protease inhibitors. Patients with G1 HCV, who