caa a22 4500 445796359 CHVBK 20180317145126.0 cr unu---uuuuu 170323e20110801xx s 000 0 eng 10.1007/s10620-011-1746-3 doi (NATIONALLICENCE)springer-10.1007/s10620-011-1746-3 Retreatment of Hepatitis C with Consensus Interferon and Ribavirin After Nonresponse or Relapse to Pegylated Interferon and Ribavirin: A National VA Clinical Practice Study [Elektronische Daten] [Helen Yee, Sue Currie, Kathryn Tortorice, Myrna Cozen, Hui Shen, Summer Chapman, Fran Cunningham, Alexander Monto] Background: Studies of the retreatment with consensus interferon (CIFN) and ribavirin (RBV) of hepatitis C virus (HCV)-infected patients who failed prior pegylated interferon alfa/ribavirin (PEG-IFN/RBV) have found quite variable efficacy and tolerability of this therapy. As such, CIFN/RBV use and efficacy in clinical practice were evaluated within the Department of Veterans Affairs (VA), the largest national, integrated system for HCV care. Aims: The purpose of this study was to determine rates of sustained virologic response (SVR) and patterns of CIFN/RBV use in the VA. Methods included retrospective review of national VA data in HCV-infected patients who had previously failed ≥12weeks of PEG-IFN/RBV and were prescribed CIFN/RBV between October 1, 2003 and September 30, 2006. Results: A total of 597 patients met the study criteria. CIFN was primarily dosed as 15 mcg subcutaneously daily combined with standard doses of RBV. Mean treatment duration was 21weeks; CIFN was discontinued within 4weeks in 24%. Hematological growth factors were used in 49%. Post-treatment viral loads were available in 385 patients. SVR to CIFN/RBV was achieved in 11%, and was significantly higher in prior PEG-IFN/RBV relapsers compared with nonresponders (31% vs. 6%, respectively; P<0.0001). A 2-log10 or greater drop in HCV RNA after 24weeks of PEG-IFN/RBV was a predictor of subsequent SVR to CIFN/RBV. Conclusions: CIFN/RBV was used frequently in clinical practice for retreatment of PEG-IFN/RBV. In this setting, early treatment discontinuation was common. Overall SVR was low, although response was significantly better in prior PEG-IFN/RBV relapsers and those who had a 2-log10 or greater decline than in nonresponders. Springer Science+Business Media, LLC (Outside the USA), 2011 Consensus interferon nationallicence Hepatitis C virus nationallicence Nonresponders nationallicence Pegylated interferon/ribavirin nationallicence Retreatment nationallicence CIFN : Consensus interferon nationallicence DIRECT : Daily-dose consensus interferon and ribavirin: Efficacy of combined therapy nationallicence HCV : Hepatitis C virus nationallicence PEG-IFN : Pegylated interferon alfa nationallicence IFN : Interferon nationallicence PBM : Pharmacy Benefits Management nationallicence RBV : Ribavirin nationallicence SVR : Sustained virologic response nationallicence HCV RNA : Hepatitis C virus ribonucleic acid level nationallicence VA : Veterans Affairs nationallicence ICD-9 : International classification of diseases, ninth revision nationallicence NPF : National Patient Files nationallicence CPT-4 : Coding for procedures performed, fourth revision nationallicence HIV : Human immunodeficiency virus nationallicence Yee Helen Gastroenterology Section, Department of Veterans Affairs Medical Center (VAMC), 4150 Clement Street (111B), 94121, San Francisco, CA, USA aut Currie Sue Clinical Care Options, Reston, VA, USA aut Tortorice Kathryn Department of Veterans Affairs Pharmacy Benefits Management Services, Hines, IL, USA aut Cozen Myrna Gastroenterology Section, Department of Veterans Affairs Medical Center (VAMC), 4150 Clement Street (111B), 94121, San Francisco, CA, USA aut Shen Hui Gastroenterology Section, Department of Veterans Affairs Medical Center (VAMC), 4150 Clement Street (111B), 94121, San Francisco, CA, USA aut Chapman Summer Department of Veterans Affairs Pharmacy Benefits Management Services, Hines, IL, USA aut Cunningham Fran Department of Veterans Affairs Pharmacy Benefits Management Services, Hines, IL, USA aut Monto Alexander Gastroenterology Section, Department of Veterans Affairs Medical Center (VAMC), 4150 Clement Street (111B), 94121, San Francisco, CA, USA aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/8(2011-08-01), 2439-2448 0163-2116 56:8<2439 2011 56 10620 https://doi.org/10.1007/s10620-011-1746-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-011-1746-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Yee Helen Gastroenterology Section, Department of Veterans Affairs Medical Center (VAMC), 4150 Clement Street (111B), 94121, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Currie Sue Clinical Care Options, Reston, VA, USA aut NATIONALLICENCE 700 1- Tortorice Kathryn Department of Veterans Affairs Pharmacy Benefits Management Services, Hines, IL, USA aut NATIONALLICENCE 700 1- Cozen Myrna Gastroenterology Section, Department of Veterans Affairs Medical Center (VAMC), 4150 Clement Street (111B), 94121, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Shen Hui Gastroenterology Section, Department of Veterans Affairs Medical Center (VAMC), 4150 Clement Street (111B), 94121, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Chapman Summer Department of Veterans Affairs Pharmacy Benefits Management Services, Hines, IL, USA aut NATIONALLICENCE 700 1- Cunningham Fran Department of Veterans Affairs Pharmacy Benefits Management Services, Hines, IL, USA aut NATIONALLICENCE 700 1- Monto Alexander Gastroenterology Section, Department of Veterans Affairs Medical Center (VAMC), 4150 Clement Street (111B), 94121, San Francisco, CA, USA aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/8(2011-08-01), 2439-2448 0163-2116 56:8<2439 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer