유전자 1형 만성 C형간염 환자에서 페그인터페론과 리바비린의 24주와 48주 치료 효과 비교
A comparison of 24- vs. 48-week peginterferon plus ribavirin in patients with genotype 1 chronic hepatitis C
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목적: 유전자 1형 만성 C형간염의 표준치료는 페그인터페론과 리바비린의 48주 병합요법이다. 치료에 따르는 부작용과 비용 때문에 가장 적절한 치료기간을 찾고자 하는 연구들이 시도되고 있다. 본 연구에서는 유전자 1형 만성 C형간염 환자에서 페그인터페론과 리바비린 병합요법으로 24주 또는 48주 동안 치료한 성적을 알아보고, 분할 24주 치료(24주 치료한 환자에서 재발한 환자를 대상으로 추가 24주 치료를 시행)의 효과에 대해 알아보고자 하였다. 대상과 방법: 130명의 유전자 1형 만성 C형간염 환자를 대상으로 하였다. 치료 후 24주째에 HCV RNA 정성검사를 시행하여, HCV RNA가 음성으로 나온 환자들에서 24주 또는 48주의 치료기간을 결정하였다. 52명의 환자가 24주 치료를 선택하였으며, 50명의 환자가 48주 치료를 선택하였다. 24주 치료를 선택한 환자에서 치료 종료 후 재발이 확인된 환자는 추가 24주 치료를 받도록 하였다. 각 치료군에서 지속바이러스반응(sustained virologic response, SVR)률을 분석하였다. 결과: 48주 치료군의 SVR률(74.0%)이 24주 치료군의 SVR률(52.9%)보다 높았다. SVR에 영향을 미치는 요인에 대한 다변량 분석에서 50세 미만, 혈소판 수치 15만 이하 및 48주 치료기간이 SVR에 영향을 주는 독립적인 인자로 나타났다. 24주 치료군 중 재발한 24명 중 14명이 분할 24주 치료를 마쳤으며, 6명에서 SVR이 추가로 확인되었다. 결론: 본 연구의 결과는 유전자 1형 환자 중 선택된 환자들에서 24주 치료를 시도할 수 있고, 분할 24주 치료가 24주 치료를 시도할 수 있는 유용한 근거가 될 수 있음을 보여준다.
Abstract
Background/Aims: The standard therapy for patients with genotype 1 chronic hepatitis C (CHC) is a combination of peginterferon and ribavirin for 48 weeks. However, the most appropriate duration of treatment remains to be established because of treatment-related side effects and cost. The aim of this study was to compare the efficacies of 24- and 48-week treatments, and to assess the efficacy of split 24-week therapy (a further 24 weeks of treatment in patients with relapse after the initial 24 weeks of treatment). Methods: A total of 130 patients with genotype 1 CHC was treated between June 2004 and December 2006. Patients with undetectable HCV RNA at 24 weeks of treatment (as assessed by qualitative PCR assay; n=101 patients) were allowed to choose either 24 or 48 weeks as the duration of their treatment; 51 patients chose the 24-week treatment regimen and the remainder chose the 48-week regimen. Patients who relapsed after 24 weeks of treatment were treated for further 24 weeks. The sustained virologic response (SVR) of each treatment group was analyzed. Results: The SVR rate was higher in patients treated for 48 weeks than in those treated for 24 weeks (74.0% vs. 52.9%, P=0.028). In the multivariate analysis, age < 50 years, platelets ≥ 150,000/mm3, and treatment duration for 48 weeks remained significant independent predictors of SVR. Fourteen of the 24 patients who relapsed in the 24-week treatment group received split 24-week therapy, and 6 patients (42.9%) achieved SVR. The overall SVR rate did not differ significantly between the 24-week treatment group, including those who underwent 24-week split therapy (64.7%), and the 48-week treatment group (64.7% vs. 74%, P=0.311). Conclusions: The 24-week plus additional split 24-week therapy following failure is a useful treatment strategy for patients with genotype 1 CHC.
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