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Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals

Received: 12 July 2019     Accepted: 20 August 2019     Published: 9 September 2019
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Abstract

In treating hepatitis C infection, identification of reliable markers predicting virological non-response appear central to improving outcome and to prompting changes in dynamic treatment approaches. The interrelationship of ribavirin (RBV) concentrations and laboratory variables with clinical outcomes was evaluated in HCV patients treated with ribavirin, and with or without early direct acting antivirals (DAA). Correlations between RBV concentration, laboratory variables (haemoglobin, absolute lymphocyte, platelet and neutrophil counts, serum creatinine and hepatitis C viral load) and patients’ characteristics associated with sustained virological response (SVR) were investigated using multivariate analysis. The 76 patients studied all received interferon (INF) and RBV, with 37 additionally given Boceprevir or Telaprevir. Significant correlations were noted between week 1 RBV concentration and subsequent total exposure at weeks 2, 4 and 12 (P < 0.0001). RBV concentrations in excess of 1.0 mg/L (week 1) and 2.0 mg/L (week 2) provided targets for avoiding breakthrough (P < 0.05). SVR was greater in patients without cirrhosis (73.3% vs. 41.3%; P < 0.01). All patients with an absolute haemoglobin (Hb) fall >30 g/L (week 8) experienced higher SVR rates (P < 0.03). RBV concentrations above 2.7 mg/L at week 4 or later increased the likelihood of Hb falls >30 g/L. Six factors were predictive of SVR in univariate analysis, and three in multivariate analysis. There is an association between SVR and absolute lymphocyte count, IL-28B CC genotype, and HCV-RNA load fall at week 1 (>80 %) or week 2 (>90 %) in HCV patients treated with INF/RBV and early DAA.

Published in European Journal of Clinical and Biomedical Sciences (Volume 5, Issue 3)
DOI 10.11648/j.ejcbs.20190503.13
Page(s) 51-57
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Hepatitis C, Antiviral Therapy, Direct-acting Antivirals, Ribavirin, Cirrhosis

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Cite This Article
  • APA Style

    Halina Michur, Phillip Morgan, Ivana Carey, Nigel Brown, Nigel Heaton, et al. (2019). Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals. European Journal of Clinical and Biomedical Sciences, 5(3), 51-57. https://doi.org/10.11648/j.ejcbs.20190503.13

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    ACS Style

    Halina Michur; Phillip Morgan; Ivana Carey; Nigel Brown; Nigel Heaton, et al. Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals. Eur. J. Clin. Biomed. Sci. 2019, 5(3), 51-57. doi: 10.11648/j.ejcbs.20190503.13

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    AMA Style

    Halina Michur, Phillip Morgan, Ivana Carey, Nigel Brown, Nigel Heaton, et al. Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals. Eur J Clin Biomed Sci. 2019;5(3):51-57. doi: 10.11648/j.ejcbs.20190503.13

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  • @article{10.11648/j.ejcbs.20190503.13,
      author = {Halina Michur and Phillip Morgan and Ivana Carey and Nigel Brown and Nigel Heaton and Michael Heneghan and Kosh Agarwal and John Michael Tredger},
      title = {Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals},
      journal = {European Journal of Clinical and Biomedical Sciences},
      volume = {5},
      number = {3},
      pages = {51-57},
      doi = {10.11648/j.ejcbs.20190503.13},
      url = {https://doi.org/10.11648/j.ejcbs.20190503.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20190503.13},
      abstract = {In treating hepatitis C infection, identification of reliable markers predicting virological non-response appear central to improving outcome and to prompting changes in dynamic treatment approaches. The interrelationship of ribavirin (RBV) concentrations and laboratory variables with clinical outcomes was evaluated in HCV patients treated with ribavirin, and with or without early direct acting antivirals (DAA). Correlations between RBV concentration, laboratory variables (haemoglobin, absolute lymphocyte, platelet and neutrophil counts, serum creatinine and hepatitis C viral load) and patients’ characteristics associated with sustained virological response (SVR) were investigated using multivariate analysis. The 76 patients studied all received interferon (INF) and RBV, with 37 additionally given Boceprevir or Telaprevir. Significant correlations were noted between week 1 RBV concentration and subsequent total exposure at weeks 2, 4 and 12 (P P P 30 g/L (week 8) experienced higher SVR rates (P 30 g/L. Six factors were predictive of SVR in univariate analysis, and three in multivariate analysis. There is an association between SVR and absolute lymphocyte count, IL-28B CC genotype, and HCV-RNA load fall at week 1 (>80 %) or week 2 (>90 %) in HCV patients treated with INF/RBV and early DAA.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals
    AU  - Halina Michur
    AU  - Phillip Morgan
    AU  - Ivana Carey
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    JF  - European Journal of Clinical and Biomedical Sciences
    JO  - European Journal of Clinical and Biomedical Sciences
    SP  - 51
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    PB  - Science Publishing Group
    SN  - 2575-5005
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    AB  - In treating hepatitis C infection, identification of reliable markers predicting virological non-response appear central to improving outcome and to prompting changes in dynamic treatment approaches. The interrelationship of ribavirin (RBV) concentrations and laboratory variables with clinical outcomes was evaluated in HCV patients treated with ribavirin, and with or without early direct acting antivirals (DAA). Correlations between RBV concentration, laboratory variables (haemoglobin, absolute lymphocyte, platelet and neutrophil counts, serum creatinine and hepatitis C viral load) and patients’ characteristics associated with sustained virological response (SVR) were investigated using multivariate analysis. The 76 patients studied all received interferon (INF) and RBV, with 37 additionally given Boceprevir or Telaprevir. Significant correlations were noted between week 1 RBV concentration and subsequent total exposure at weeks 2, 4 and 12 (P P P 30 g/L (week 8) experienced higher SVR rates (P 30 g/L. Six factors were predictive of SVR in univariate analysis, and three in multivariate analysis. There is an association between SVR and absolute lymphocyte count, IL-28B CC genotype, and HCV-RNA load fall at week 1 (>80 %) or week 2 (>90 %) in HCV patients treated with INF/RBV and early DAA.
    VL  - 5
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Author Information
  • Institute of Liver Studies, King’s College Hospital, London, UK

  • Institute of Liver Studies, King’s College Hospital, London, UK

  • Institute of Liver Studies, King’s College Hospital, London, UK

  • Department of Clinical Chemistry, Wansbeck General Hospital, Ashington, UK

  • Institute of Liver Studies, King’s College Hospital, London, UK

  • Institute of Liver Studies, King’s College Hospital, London, UK

  • Institute of Liver Studies, King’s College Hospital, London, UK

  • Institute of Liver Studies, King’s College Hospital, London, UK

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