830 CHOLESTEROL LEVELS AND PRESENCE OF DIABETES PREDICT EARLY VIROLOGICAL RESPONSE TO TRIPLE THERAPY...
Transcript of 830 CHOLESTEROL LEVELS AND PRESENCE OF DIABETES PREDICT EARLY VIROLOGICAL RESPONSE TO TRIPLE THERAPY...
![Page 1: 830 CHOLESTEROL LEVELS AND PRESENCE OF DIABETES PREDICT EARLY VIROLOGICAL RESPONSE TO TRIPLE THERAPY WITH TELAPREVIR, PEG-INTERFERON alfa-2a 180 μg AND RIBAVIRIN IN CHRONIC HEPATITIS](https://reader036.fdocument.org/reader036/viewer/2022082618/575098cc1a28abbf6bdf4fac/html5/thumbnails/1.jpg)
POSTERS
Methods: We examined 15 patients, nine male and six female, aged
between 24 and 66 years. The patients have been treated with Peg-
IFN (180mg/week), Ribavirin and in some cases with Boceprevir
or Telaprevir. During the treatment the patient’s weight has been
monitored. Also the patients have been interviewed about other
side effects and their general well-being. In order to find out wether
patients lose rather fat, water or muscles our approach was to run
a bioelectrical impedance analysis. For our analysis Akern BIA 101/s
was used. The patients have been examined in the beginning, in
week 4 and in week 12 of the therapy.
Results: Within all tested patients we found a loss of weight. The
medial weight of 76.8 kg was reduced to 74.4 kg which equates 3.2%
weight loss. The phase angle decreases due to the catabolic stimulus
we found as a result of the bioelectrical impedance analysis (PA
7.08 to PA 6.85) which means patients lose rather muscle-cells
than fat-cells. In 3 patients with a telaprevir based triple therapy
the reduction however was much higher. In the first four weeks of
the treatment the phase angle in the Peg-IFN and Ribavirin group
stays almost the same (medial PA 7.01 to PA 7.0), in the group with
Telaprevir the phase angle decreases (PA 7.4 to PA 6.6).
Conclusion: A IFN-based HCV treatment results in a median weight
loss of 3.2% in the first 12 weeks. The weight loss is due to a loss
of muscle mass. In a telaprevir based triple therapy the muscle
loss seems to be heigher. Sports or a protein rich diet may reduce
muscle loss.
830
CHOLESTEROL LEVELS AND PRESENCE OF DIABETES PREDICT
EARLY VIROLOGICAL RESPONSE TO TRIPLE THERAPY WITH
TELAPREVIR, PEG-INTERFERON alfa-2a 180mg AND RIBAVIRIN
IN CHRONIC HEPATITIS C
E. Jaeckel1, E. Zehnter2, C. John3, R. Heyne4, G. Teuber5,
W. Schiffelholz6, S. Christensen7, C. Antoni8, S. Pape9, M. Roessle10,
H. Loehr11, S. Stoll12, U. Alshuth12, D. Hueppe13, S. Mauss14,
M.P. Manns1, BNG Study Group. 1Dept. of Gastroenterology,
Hepatology & Endocrinology, Hannover Medical School, Hannover,2Center of Gastroenterology, Dortmund, 3Center of Gastroenterology,4Center of Gastroenterology and Liver Center, Berlin, 5IFS,
Interdisziplinaeres Facharztzentrum Sachsenhausen, Frankfurt/M,6Center of Gastroenterology, Augsburg, 7Center for Interdisciplinary
Medicine, Muenster, 8II. Medizinische Universitaetsklinik,
Universitaetsmedizin Mannheim, Mannheim, 9Center of
Gastroenterology, Paderborn, 10Gastrointestinal and Endocrinological
Center, Freiburg, 11Center of Gastroenterology, Wiesbaden, 12Virology,
Roche Pharma AG, Grenzach-Wyhlen, 13Center of Gastroenterology,
Herne, 14Center for HIV and Hepatogastroenterology, Duesseldorf,
Germany
E-mail: [email protected]
Background: We previously reported data that markers of the
metabolic syndrome such as BMI, blood sugar, hypertension and
lipid markers influence the SVR to dual therapy with PEG-
interferon alfa-2a 180mg/ribavirin. These data were generated by
a German-wide, observational study conducted by the German
gastroenterologists in private practice in cooperation with Roche
since 2003. Since 2011 the German gastroenterologists in private
practice are conducting another German-wide, observational study
in cooperation with Roche. Within this observational study
metabolic risk factors are investigated in patients receiving triple
therapy of telaprevir, PEG-interferon alfa-2a 180mg/ribavirin.Results: Within this interim analysis data of 881 patients were
evaluated for metabolic risk markers. 64.6% were male, median age
was 49.2 years, median BMI 26.2 kg/mm2, 27.5% of patients had an
BMI>28. Duration of infection was 17.1 years, 27.8% of patients had
blood glucose levels >100mg/dL. Early virological response was
defined as HCV-RNA negative or <10IU/mL at week12. EVR was
achieved by 58.7% of patients under triple therapy of telaprevir,
PEG-interferon alfa-2a 180mg, ribavirin. In contrast to dual therapy
markers of the metabolic syndrome such as BMI, hypertension,
blood glucose, HbA1c and HDL were not associated with non-
response in this group. Neither gender nor duration of infection
or viral load were predictive for non EVR. Only diabetes, baseline
cholesterol and LDL levels were predictive of achieving an EVR.
Patients with cholesterol >190mg/dl experienced an EVR in 65.7%
compared to just 55.4% EVR in patients with lower cholesterol
(p = 0.05). Likewise patients with LDL >160mg/dl had an EVR in
92.3% compared to just 53.2% with lower LDL levels (p = 0.006).
In contrast to results in dual therapy where presence of diabetes
predicted non-response, patients with diabetes achieved an EVR in
70.3% of patients compared to 57.8 in patients without diabetes
(p = 0.05).
Conclusions: None of the classical viral and host markers like viral
load and duration of infection did predict EVR in telaprevir based
triple therapy. The better treatment response with increased LDL
and cholesterol levels could highlight their importance in viral
replication. In contrast to dual therapy diabetes seems to predict a
better treatment response in telaprevir based triple therapy.
831
DELAYED DECLINE OF ON-TREATMENT HEMOGLOBIN
WAS ASSOCIATED WITH BETTER SUSTAINED VIROLOGICAL
RESPONSES IN GENOTYPE-2 CHRONIC HEPATITIS C PATIENTS
RECEIVING PEG-IFN/RBV TREATMENT
W.-J. Jeng, C.-Y. Lin, C.-W. Huang, C.-H. Huang, W.-T. Chen,
T.-C. Chang, I.-S. Sheen. Division of Hepatology, Chang Gung
University College of Medicine, Chang Gung Memorial Hospital, Lin
Kou, Taipei, Taiwan R.O.C.
E-mail: [email protected]
Background: Anemia is a troublesome adverse effect during
the PegIFN/RBV treatment for patients with chronic hepatitis C.
Recently, some evidence had shown that the occurrence of anemia,
especially the late anemia is associated with better sustained
virological responses (SVR) in genotype 1 patients.
Aim: To assess the impact of on-treatment hemoglobin decline on
SVR rate in patients with genotype-2 (GT-2) chronic hepatitis C
(CHC) who received PegIFN/RBV treatment.
Method: This is a retrospective analysis of our CHC cohort. HCV
genotyping and quantification were performed. The hemoglobulin
(Hgb) concentrations were measured on week 2, week 4 and
subsequent every 4 weeks during treatment. Blood transfusion,
administration of erythropoietin (EPO) or adjustment of RBV dosage
were used according to the preference of the patients when the
Hb below 10g/ml. The timing of the initial Hgb decline 3 g/ml was
recorded.
Results: There were 309 GT2 CHC patients who received
PegIFN/RBV treatment in this study. There were 236 (76.4%) patients
whose Hgb had decline more than 3g/ml during the treatment.
Those Hgb decline >3 after week 2 on treatment were easier to
achieved SVR (93.7%) than those without decline of Hgb or decline
before week 2 (86.3%). The predictor of SVR by logistic regression
are patients whose Hgb decline more than 3g/ml after 2 weeks on
treatment (OR: 2.93, 95%CI: 1.13–7.64, p = 0.028), those with RVR
(OR: 5.36, 95%CI: 2.1–13.66, p < 0.001), and with baseline higher
platelet count (OR: 1.01, 95%CI: 1.00–1.02, p = 0.01). By comparison
of baseline characteristics between those on-treatment decline of
hemoglobin <3 and ≥3, there were no differences in terms of age,
baseline viral load, fibrosis status, and RVR rate. However, men
are easier to have the decline of hemoglobin during treatment
rather than women (p =0.001). Other factors related to decline
of hemoglobin >3 during treatment are baseline creatinine and
baseline hemoglobin.
Conclusion: The decline of hemoglobin >3 after 2 weeks on
treatment, as well as higher baseline platelet count and RVR would
S340 Journal of Hepatology 2013 vol. 58 | S229–S407