On the other hand, disadvantages associated with antiviral therapy include potential long term safety concerns, emergence PARP inhibitor of resistant mutants and financial burden.
Available data and clinical experience guide the physician to balance these factors in individual patients. While the introduction of the new class of direct agents against hepatitis C virus (HCV) is eagerly awaited, clinicians rely on optimal use of the current standard-of-care medications to maximize patient’s response. First, recent evidence points to the need for weight-based therapy. This is especially true of ribavirin – there are benefits of increasing ribavirin doses up to 1400 mg per day in genotype 1 patients with a body weight greater than 105 kg. Even for genotype 2 or 3 patients for whom the standard ribavirin dose is 800mg per day, weight-based dosing similar to genotype 1 patients may be more effective. Second, treatment LY294002 price duration may be tailored based on on-treatment response. In genotype 1 patients whose serum HCV RNA is negative at week four (‘rapid viral response’), treatment may be shortened to 24 weeks. If HCV RNA becomes negative
at week 12, the standard 48 week duration is applicable, whereas in those whose HCV RNA does not become negative until 24 weeks, prolonging the duration to 72 weeks may increase the response rate by up to 20%. Shortening therapy duration to 12-16 weeks in genotype 2/3 patients with rapid viral response is a bit more controversial – it may be considered in patients whose tolerance is poor, especially if ribavirin is dosed according to the weight “
“Polymorphisms of
the IL28B gene are highly associated with sustained virological response (SVR) in patients with chronic hepatitis C treated with peginterferon and ribavirin. Quantitation of interferon-γ–inducible protein-10 (IP-10) may also differentiate antiviral response. We evaluated IP-10 levels in pretreatment serum from 115 nonresponders and 157 sustained responders in the Study of Viral Resistance to Antiviral Therapy of Chronic Hepatitis C cohort, including African American (AA) and Caucasian American (CA) patients. Mean MCE公司 IP-10 was lower in sustained responders compared with nonresponders (437 ± 31 vs 704 ± 44 pg/mL, P< 0.001), both in AA and CA patients. The positive predictive value of low IP-10 levels (<600 pg/mL) for SVR was 69%, whereas the negative predictive value of high IP-10 levels (>600 pg/mL) was 67%. We assessed the combination of pretreatment IP-10 levels with IL28B genotype as predictors of treatment response. The IL28B polymorphism rs12979860 was tested in 210 participants. The CC, CT, and TT genotypes were found in 30%, 49%, and 21% of patients, respectively, with corresponding SVR rates of 87%, 50%, and 39% (P< 0.0001). Serum IP-10 levels within the IL28B genotype groups provided additional information regarding the likelihood of SVR (P< 0.0001).
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