만성 C형간염에서 페그인터페론과 리바비린의 병합치료 시 지속바이러스반응에 대한 순응도의 효과
Impact of adherence to peginterferon-ribavirin combination therapy in chronic hepatitis C patients on achieving a sustained virologic response
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목적: 만성 C형간염에서 페그인터페론과 리바비린 병합요법 치료 시 지속바이러스반응에 영향을 미치는 다양한 예측인자들이 알려져 있지만, 치료순응도의 효과에 대해서는 구체적으로 밝혀져 있지 않다. 본 연구에서는 지속바이러스반응에 대한 치료순응도의 효과를 조사하였다. 대상과 방법: 페그인터페론 또는 리바비린 치료를 받은 만성 C형간염 환자 122명 중에서 페그인터페론과 리바비린 병합치료를 받은 92명의 환자를 후향적으로 분석하였다. 환자들은 유전자 1형과 비1형을 치료 프로토콜에 따라서 각각 3그룹으로 분류하였다. 그룹 1은 80% 이상의 페그인터페론 및 리바비린 용량으로 80% 이상의 치료 기간 동안 치료받은 환자들이고, 그룹 2는 60% 미만의 페그인터페론 및 리바비린의 용량으로 60%미만의 기간 동안 치료받은 환자들이며 그리고 그룹 3은 이 두 그룹에 포함되지 않은 모든 환자들로 분류하였다. 결과: 치료 순응도가 달랐던 세 그룹 사이에 초기바이러스반응(early virologic response: EVR), 치료종료반응(end of treatment response: ETR) 그리고 지속바이러스반응(sustained virologic response: SVR)이 각각 의미있는 차이를 보였다. 유전자 1형 그룹들의 SVR률은 그룹 1이 86.7%, 그룹 2가 26.7% 그리고 그룹 3이 66.7%였다(P=0.003). 유전자 비1형 그룹들의 SVR은 그룹 1이 100%, 그룹 2가 16.7% 그리고 그룹 3이 88.9%였다(P<0.001). 결론: 치료순응도는 SVR에 도달하는 데 있어서 결정적인 역할을 하며, 치료 순응도를 높이기 위한 여러 가지 지지요법들이 전체적인 SVR률을 높일 것이다.
Abstract
Background/Aims: Various predictive factors for peginterferon alpha and ribavirin therapy in chronic hepatitis C have been reported, but the effect of adherence to therapy has not been established. We investigated how adherence affects the sustained virologic response (SVR). Methods: We analyzed 92 chronic hepatitis C patients receiving peginterferon alpha and ribavirin combination therapy. Patients were first identified as having either genotype 1 or genotype non-1 infection and then categorized into three groups according to their adherence to the treatment protocol: (1) patients who received ≥80% of the recommended dosage of both peginterferon alpha and ribavirin for ≥80% of the intended duration of therapy, (2) patients who received <60% of the recommended dosage of both peginterferon alpha and ribavirin for <60% of the intended duration of therapy, and (3) patients who were not included in either group 1 or 2. Results: The rates of early virologic response, end of treatment response, and SVR differed significantly with the degree of adherence to the treatment. The SVRs of genotype 1 patients were 86.7%, 26.7%, and 66.7% in groups 1, 2, and 3, respectively (P=0.003), and those of genotype non-1 were 100%, 16.7%, and 88.9%, respectively (P<0.001). Conclusions: Adherence to therapy is a key factor in achieving an SVR. Supportive strategies to improve adherence will increase overall SVR rates.
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