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Treatment for Hepatitis C Virus Infection in Adults: Comparative Effectiveness

Slide: 17 of 34

Dual Therapy Containing Pegylated Interferon Alfa-2a Versus Dual Therapy Containing Pegylated Interferon Alfa-2b (2 of 2)

Four randomized trials of dual therapy with pegylated interferon alfa-2a plus ribavirin versus dual therapy with pegylated interferon alfa-2b plus ribavirin found that the absolute sustained virologic response (SVR) rates were 24–42 percent lower in patients with hepatitis C virus (HCV) genotype 1 infection when compared with patients with HCV genotype 2 or 3 infection. No clear differences in relative risk estimates for an SVR were found when patients were stratified by genotype. The strength of evidence for this finding was rated moderate.

A large study, the IDEAL (Individualized Dosing Efficacy vs. Flat Dosing to Assess Optimal Pegylated Interferon Therapy) trial, which enrolled 3,070 patients with HCV genotype 1 infection, found that the overall absolute SVR rates across dual-therapy regimens were lower in older (38%) versus younger (53–56%) patients, black patients (23–26%) versus white patients (53–55%), patients with stage F3 or F4 (21– 24%) versus stage F0 to F2 (42–44%) fibrosis, and patients with high (35–36 percent) versus low (61–66 percent) viral load. However, there were no clear differences in relative risk estimates for an SVR when patients were stratified by age, race, baseline fibrosis, and baseline viral load. The strength of evidence was rated low.