HCV Treatment for African-Americans

As you can seefrom the first abstract African-Americans did not respond well to interferon treatment for HCV in this study. The reasons why have not yet been well evaluated. Their end-of-tretment response and sustained response was 5% and 2%, respectively. However, I repeated another abstract below showing that you may be able improve African-Americans response to therapy. in this second study they used 5 MIU daily for induction and then reverted to 3MIU TIW.

Racial Differences in Responses to Therapy With Interferon in Chronic Hepatitis C
Hepatology, September 1999, p. 787-793, Vol. 30, No. 3

K. Rajender Reddy1, Jay H. Hoofnagle2, Myron J. Tong3, William M. Lee4, Paul Pockros5, E. Jenny Heathcote6, Donald Albert7, and Tenshang John for the for the Consensus Interferon Study Group

From the 1University of Miami, Miami, FL; 2Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD; Huntington Memorial Hospital, Pasadena, CA; 4University of Texas, Southwestern Medical Center, Dallas, TX; 5Scripps Clinic, La Jolla, CA; 6University of Toronto, Toronto, Ontario, Canada; and 7Amgen, Inc., Boulder, CO and 8Thousand Oaks, CA.

The likelihood of a sustained response to a course of interferon in patients with chronic hepatitis C correlates with several clinical and viral factors, including age, viral genotype and initial levels of hepatitis C virus (HCV) RNA in serum. The role of race and ethnicity has not been assessed. We evaluated the association of race with response to interferon in a large randomized, controlled trial using either consensus interferon (9 µg) or interferon alfa-2b (3 million units) given three times weekly for 24 weeks. African-American patients participating in the study were similar to white patients in mean age (43 vs. 42 years) and baseline levels of HCV RNA (3.6 vs. 3.0 million copies/mL) but had lower rates of cirrhosis (5% vs. 12%) and more frequently had viral genotype 1 (88% vs. 66%: P = .004). Most strikingly, the rates of end-of-treatment and sustained virological responses were lower among the 40 African-American patients (5% and 2%) than among the 380 white patients (33% and 12%) (P = .04 and .07). Rates of response among Hispanic and Asian-American patients were not statistically different than non-Hispanic white patients. Median viral levels decreased by week 24 of therapy by 2.5 logs in white patients (from 3.0 to 0.012 million copies/mL) but by only 0.5 logs among African- American patients (from 3.6 to 1.8 million copies/mL). Thus, there are marked racial differences in virological responses to interferon in hepatitis C that must be considered in assessing trials of interferon therapy and in counseling patients regarding treatment. The differences in response rates are as yet unexplained. (HEPATOLOGY 1999;30:787-793.)

Induction Interferon Treatment of African-Americans With Chronic Hepatitis C Results in an Enhanced Response Comparable to Caucasians Given Standard Interferon Therapy.
Firdous Siddiqui, P H Naylor, M N Ehrinpreis, R Peleman, J L Kinzie, M G Mutchnick, Wayne State Univ, Detroit, MI

African-Americans constitute the majority of patients treated for chronic hepatitis C at our institution. African-Americans respond to interferon at a much lower rate than Caucasians using the standard dose of 3MU thrice weekly. The aim of this study was to determine if an induction treatment with interferon enhanced the response rate in African-Americans. Methods: forty three interferon-naive African-American patients were treated with 5 MU of IFN alfa -2b daily for 4 weeks followed by 3 MU three times a week for 8 weeks. Ten patients withdrew from treatment prior to the 12 week interval. Serum hepatitis C viral (HCV) RNA was determined at 12 weeks. If serum HCV RNA was detected at 12 weeks, treatment was discontinued. Patients with non detectable HCV RNA at 12 weeks were continued on treatment for a total of 48 weeks. Results: Eleven of the thirty three (33%) African-Americans had non-detectable HCV RNA at 12 weeks compared to a 5/55 (9%) response rate in African-Americans treated with standard 3 MU of IFN three times a week at our institution. The response observed with induction therapy in African-Americans compared favorably to the 14/40 (28%) response rate seen in our Caucasian population treated with 3 MU of interferon three times a week. The withdrawal rate in patients treated with induction interferon was 10/43 (23%) compared to 15/141(10%) in a cohort of patients treated with standard 3 MU interferon three times a week.

Conclusions: The poor response to interferon treatment of African-American patients with chronic hepatitis C can be overcome by a more intensive regimen of interferon but the withdrawal rate increases with this approach.