Response and predictors of response, to pegylated interferon and ribavirin for chronic hepatitis C patients in Scotland: alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) are valuable pre-treatment markers of an SVR in routine clinical practice

H. Innes, S. Hutchinson, S. Allen, D. Bhattacharyya, P. Bramley, B. Carman, T. Delahooke, J. Dillon, D. Goldberg, N. Kennedy

Research output: Contribution to journalConference Contribution

15 Citations (Scopus)

Abstract

It is not clear what proportion of HCV (hepatitis C virus) patients attain a sustained viral response (SVR) when treated with pegylated interferon and ribavirin combination therapy outside randomised clinical trials (RCTs). Secondly, pre-treatment factors available in routine clinical settings that are predictive of SVR (the optimal treatment outcome) are not known. HCV clinical databases from nine Scottish treatment clinics were used to derive a retrospective cohort of 934 patients initiated on HCV treatment during 2000–2007. In our cohort, 39% (123/315, 95% CI 34% to 45%) of genotype (GT) 1, and 70% (414/594, 95% CI 66% to 73%) of genotype 2/3 (GT2/3) patients achieved a SVR; this compares with pooled estimates of 47% for GT1 (95% CI 41% to 52%), and 80% for GT2/3 (95% CI 75% to 85%) patients from RCTs. Pre-treatment factors significantly associated with SVR were: gamma glutamyl transferase (GGT) ≥55 IU/l (adjusted OR: 0.46, 95% CI 0.33 to 0.65), platelet count ≥150×109/l (1.92, 95% CI 1.26 to 2.93), ALT quotient ≥2.5 (for those GT1 infected: 2.66, 95% CI 1.46 to 4.84), GT2/3 (for those with ALT quotient <2.5: 4.05, 95% CI 2.82 to 5.80; and for those with ALT quotient ≥2.5: 1.91, 95% CI 1.01 to 3.61), age (per ten year increase) (0.84, 95% CI 0.72 to 0.99), ever HBV infection (0.67, 95% CI 0.45 to 0.98), and male gender (0.70, 95% CI 0.50 to 0.98). The principal conclusions are twofold: (1) the proportion of patients attaining a SVR in Scottish routine practice is marginally lower than in RCTs, and (2) in addition to genotype, GGT (in all patients) and ALT (in GT1 patients only) emerge as valuable predictors of an SVR in the routine clinical setting.
LanguageEnglish
Article numberP2-122
PagesA254-A254
Number of pages1
JournalJournal of Epidemiology and Community Health
Volume65
Issue numberSupplement 1
DOIs
Publication statusPublished - Aug 2011
EventIEA World Congress of Epidemiology - Edinburgh, United Kingdom
Duration: 7 Aug 201111 Aug 2011

Fingerprint

Ribavirin
Scotland
Chronic Hepatitis C
Transferases
Alanine Transaminase
Interferons
Biomarkers
Genotype
Hepacivirus
Randomized Controlled Trials
Therapeutics
Platelet Count
Databases
Infection

Keywords

  • clinical practice
  • hepatitis c
  • Scotland

Cite this

@article{93124212cc1a4949bbf5f94253187072,
title = "Response and predictors of response, to pegylated interferon and ribavirin for chronic hepatitis C patients in Scotland: alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) are valuable pre-treatment markers of an SVR in routine clinical practice",
abstract = "It is not clear what proportion of HCV (hepatitis C virus) patients attain a sustained viral response (SVR) when treated with pegylated interferon and ribavirin combination therapy outside randomised clinical trials (RCTs). Secondly, pre-treatment factors available in routine clinical settings that are predictive of SVR (the optimal treatment outcome) are not known. HCV clinical databases from nine Scottish treatment clinics were used to derive a retrospective cohort of 934 patients initiated on HCV treatment during 2000–2007. In our cohort, 39{\%} (123/315, 95{\%} CI 34{\%} to 45{\%}) of genotype (GT) 1, and 70{\%} (414/594, 95{\%} CI 66{\%} to 73{\%}) of genotype 2/3 (GT2/3) patients achieved a SVR; this compares with pooled estimates of 47{\%} for GT1 (95{\%} CI 41{\%} to 52{\%}), and 80{\%} for GT2/3 (95{\%} CI 75{\%} to 85{\%}) patients from RCTs. Pre-treatment factors significantly associated with SVR were: gamma glutamyl transferase (GGT) ≥55 IU/l (adjusted OR: 0.46, 95{\%} CI 0.33 to 0.65), platelet count ≥150×109/l (1.92, 95{\%} CI 1.26 to 2.93), ALT quotient ≥2.5 (for those GT1 infected: 2.66, 95{\%} CI 1.46 to 4.84), GT2/3 (for those with ALT quotient <2.5: 4.05, 95{\%} CI 2.82 to 5.80; and for those with ALT quotient ≥2.5: 1.91, 95{\%} CI 1.01 to 3.61), age (per ten year increase) (0.84, 95{\%} CI 0.72 to 0.99), ever HBV infection (0.67, 95{\%} CI 0.45 to 0.98), and male gender (0.70, 95{\%} CI 0.50 to 0.98). The principal conclusions are twofold: (1) the proportion of patients attaining a SVR in Scottish routine practice is marginally lower than in RCTs, and (2) in addition to genotype, GGT (in all patients) and ALT (in GT1 patients only) emerge as valuable predictors of an SVR in the routine clinical setting.",
keywords = "clinical practice, hepatitis c, Scotland",
author = "H. Innes and S. Hutchinson and S. Allen and D. Bhattacharyya and P. Bramley and B. Carman and T. Delahooke and J. Dillon and D. Goldberg and N. Kennedy",
year = "2011",
month = "8",
doi = "10.1136/jech.2011.142976i.57",
language = "English",
volume = "65",
pages = "A254--A254",
journal = "Journal of Epidemiology and Community Health",
issn = "0143-005X",
number = "Supplement 1",

}

Response and predictors of response, to pegylated interferon and ribavirin for chronic hepatitis C patients in Scotland : alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) are valuable pre-treatment markers of an SVR in routine clinical practice . / Innes, H.; Hutchinson, S.; Allen, S.; Bhattacharyya, D.; Bramley, P.; Carman, B.; Delahooke, T.; Dillon, J.; Goldberg, D.; Kennedy, N.

In: Journal of Epidemiology and Community Health, Vol. 65, No. Supplement 1, P2-122, 08.2011, p. A254-A254.

Research output: Contribution to journalConference Contribution

TY - JOUR

T1 - Response and predictors of response, to pegylated interferon and ribavirin for chronic hepatitis C patients in Scotland

T2 - Journal of Epidemiology and Community Health

AU - Innes, H.

AU - Hutchinson, S.

AU - Allen, S.

AU - Bhattacharyya, D.

AU - Bramley, P.

AU - Carman, B.

AU - Delahooke, T.

AU - Dillon, J.

AU - Goldberg, D.

AU - Kennedy, N.

PY - 2011/8

Y1 - 2011/8

N2 - It is not clear what proportion of HCV (hepatitis C virus) patients attain a sustained viral response (SVR) when treated with pegylated interferon and ribavirin combination therapy outside randomised clinical trials (RCTs). Secondly, pre-treatment factors available in routine clinical settings that are predictive of SVR (the optimal treatment outcome) are not known. HCV clinical databases from nine Scottish treatment clinics were used to derive a retrospective cohort of 934 patients initiated on HCV treatment during 2000–2007. In our cohort, 39% (123/315, 95% CI 34% to 45%) of genotype (GT) 1, and 70% (414/594, 95% CI 66% to 73%) of genotype 2/3 (GT2/3) patients achieved a SVR; this compares with pooled estimates of 47% for GT1 (95% CI 41% to 52%), and 80% for GT2/3 (95% CI 75% to 85%) patients from RCTs. Pre-treatment factors significantly associated with SVR were: gamma glutamyl transferase (GGT) ≥55 IU/l (adjusted OR: 0.46, 95% CI 0.33 to 0.65), platelet count ≥150×109/l (1.92, 95% CI 1.26 to 2.93), ALT quotient ≥2.5 (for those GT1 infected: 2.66, 95% CI 1.46 to 4.84), GT2/3 (for those with ALT quotient <2.5: 4.05, 95% CI 2.82 to 5.80; and for those with ALT quotient ≥2.5: 1.91, 95% CI 1.01 to 3.61), age (per ten year increase) (0.84, 95% CI 0.72 to 0.99), ever HBV infection (0.67, 95% CI 0.45 to 0.98), and male gender (0.70, 95% CI 0.50 to 0.98). The principal conclusions are twofold: (1) the proportion of patients attaining a SVR in Scottish routine practice is marginally lower than in RCTs, and (2) in addition to genotype, GGT (in all patients) and ALT (in GT1 patients only) emerge as valuable predictors of an SVR in the routine clinical setting.

AB - It is not clear what proportion of HCV (hepatitis C virus) patients attain a sustained viral response (SVR) when treated with pegylated interferon and ribavirin combination therapy outside randomised clinical trials (RCTs). Secondly, pre-treatment factors available in routine clinical settings that are predictive of SVR (the optimal treatment outcome) are not known. HCV clinical databases from nine Scottish treatment clinics were used to derive a retrospective cohort of 934 patients initiated on HCV treatment during 2000–2007. In our cohort, 39% (123/315, 95% CI 34% to 45%) of genotype (GT) 1, and 70% (414/594, 95% CI 66% to 73%) of genotype 2/3 (GT2/3) patients achieved a SVR; this compares with pooled estimates of 47% for GT1 (95% CI 41% to 52%), and 80% for GT2/3 (95% CI 75% to 85%) patients from RCTs. Pre-treatment factors significantly associated with SVR were: gamma glutamyl transferase (GGT) ≥55 IU/l (adjusted OR: 0.46, 95% CI 0.33 to 0.65), platelet count ≥150×109/l (1.92, 95% CI 1.26 to 2.93), ALT quotient ≥2.5 (for those GT1 infected: 2.66, 95% CI 1.46 to 4.84), GT2/3 (for those with ALT quotient <2.5: 4.05, 95% CI 2.82 to 5.80; and for those with ALT quotient ≥2.5: 1.91, 95% CI 1.01 to 3.61), age (per ten year increase) (0.84, 95% CI 0.72 to 0.99), ever HBV infection (0.67, 95% CI 0.45 to 0.98), and male gender (0.70, 95% CI 0.50 to 0.98). The principal conclusions are twofold: (1) the proportion of patients attaining a SVR in Scottish routine practice is marginally lower than in RCTs, and (2) in addition to genotype, GGT (in all patients) and ALT (in GT1 patients only) emerge as valuable predictors of an SVR in the routine clinical setting.

KW - clinical practice

KW - hepatitis c

KW - Scotland

U2 - 10.1136/jech.2011.142976i.57

DO - 10.1136/jech.2011.142976i.57

M3 - Conference Contribution

VL - 65

SP - A254-A254

JO - Journal of Epidemiology and Community Health

JF - Journal of Epidemiology and Community Health

SN - 0143-005X

IS - Supplement 1

M1 - P2-122

ER -