Importance of Medication Adherence to Peginterferon-Ribavirin Combination Therapy in Patients with Chronic Hepatitis C

Pyung Gohn Goh; Min Jung Kim; Hye Jin Kim; Hyuk Soo Eun; Eui Sik Kim; Yun Jeung Kim; Soo Youn Lee; Hee Seok Moon; Eaum Seok Lee; Seok Hyun Kim; Byung Seok Lee; Heon Young Lee

doi:10.4166/kjg.2011.57.5.294

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Goh, Kim, Kim, Eun, Kim, Kim, Lee, Moon, Lee, Kim, Lee, and Lee: Importance of Medication Adherence to Peginterferon-Ribavirin Combination Therapy in Patients with Chronic Hepatitis C

Original Article

Korean J Gastroenterol 2011;57(5):294-301.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.57.5.294

Importance of Medication Adherence to Peginterferon-Ribavirin Combination Therapy in Patients with Chronic Hepatitis C

Pyung Gohn Goh, Min Jung Kim, Hye Jin Kim, Hyuk Soo Eun, Eui Sik Kim, Yun Jeung Kim, Soo Youn Lee, Hee Seok Moon, Eaum Seok Lee, Seok Hyun Kim, Byung Seok Lee, Heon Young Lee

Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea

Correspondence to: Byung Seok Lee, Department of Internal Medicine, Chungnam National University Hospital, 33, Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: +82-42-280-7164, Fax: +82-42-257-5753, E-mail: gie001@cnuh.co.kr

Received 22 August 20102 December 2010 Accepted 6 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The combination therapy with peginterferon and ribavirin is a standard treatment for patients with chronic hepatitis C. However, because of the long duration of the treatment and many complications, the reduction of adherence frequently occur. This study aimed to assess influences of reduced medication adherence in the combination therapy of chronic hepatitis C patients.

Methods

We retrospectively reviewed the medical records of 82 patients with chronic hepatitis C who received a combination therapy with peginterferon and ribavirin. The patients were categorized into 3 subgroups on the basis of medication adherence. Group 1 comprised patients who received ≥80% of the recommended dosage of both peginterferon and ribavirin. Group 2 comprised those patients who received ≥80% of the recommended dosage of only 1 drug. The patients of Group 3 received <80% of the recommended dosage of both the drugs.

Results

Sustained virologic response (SVR)s of patients in Group 1, 2 and 3 were 85.4% (41/48), 85.7% (18/21), and 38.5% (5/13), respectively (p=0.002). SVRs of genotype 1 patients in Group 1, 2 and 3 were 84.2% (16/19), 75% (9/12), and 14.3% (1/7), respectively (p=0.003). SVRs of genotype non-1 patients in Group 1, 2 and 3 were 86.2% (25/29), 100% (9/9), and 66.7% (4/6), respectively (p=0.196). Furthermore are SVRs significantly differed with the degree of medication adherence to either peginterferon or ribavirin (p=0.003 and 0.021, respectively). In multivariate analysis, the peginterferon dose was a significant independent factor associated with SVR.

Conclusions

Medication adherence of chronic hepatitis C patients to the combination therapy with peginterferon and ribavirin is very important for achieving SVR. In particular, we think that genotype 1 patients should maintain higher adherence than genotype non-1 patients.

Keywords: Hepatitis C, Peginterferon, Ribavirin, Medication adherence

References

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Fig. 1.

Cause of dose adjustment in combination therapy (n=63).

Fig. 2.

SVR rate according to the level of treatment accomplishment. SVR, sustained virologic response.

Fig. 3.

Cause of halted period in combination therapy (n=34).

Table 1.

Characteristics of Patients at Baseline

Characteristics	Total patients (n=82)
Age (years, mean±SD)	52.4±9.3
Gender (male/female)	48/33 (58.5%/41.5%)
Genotype 1/non-1	38/44 (46.3%/53.7%)
Serum ALT level (U/L, mean ± SD)	92.6±78.6
Baseline HCV RNA Viral load (×10⁵ IU/mL)	16.7±27.3
Naïve/Re-treated group	73/9 (89%/11%)
Cirrhosis (%)	10 (12.2%)

Table 2.

SVR Rate according to Medication Adherence

Medication adherence	Patients achieving SVR
Medication adherence	n All patients (n=82)	Genotype 1 patients (n=38)	Genotype non-1 patients (n=44)
Group 1 ^a	41/48 (85.4%)	16/19 (84.2%)	25/29 (86.2%)
Group 2 ^b	18/21 (85.7%)	9/12 (75%)	9/9 (100%)
Group 3 ^c	5/13 (38.5%)	1/7 (14.3%)	4/6 (66.7%)
p-value	0.002	0.003	0.196

SVR, sustained virologic response.

^a Patients who received ≥80% of the recommended dosage of both peginterferon and ribavirin.

^b Patients who received ≥80% of the recommended dosage of only 1 drug and ＜80% of the recommended dosage of other drug.

^c Patients who received ＜80% of the recommended dosage of both peginterferon and ribavirin.

Table 3.

Univariate Analysis for Factors Influencing SVR

	Patients achieving SVR (n=64)	Patients without SVR (n=18)	p-value
Gender
Male	40 (62.5%)	8 (44.4%)
Female	24 (37.5%)	10 (55.6%)	0.170
Age (years)	51.9±9.5	54.5±8.2	0.302
Genotype
Type 1	26 (40.6%)	12 (66.7%)
Type non-1	38 (59.4%)	6 (33.3%)	0.050
HCV viral load
HCV RNA (×10⁵)	17.0±30.4	15.7±10.7	0.853
HCV RNA ≥8×10⁵	33 (51.6%)	13 (72.2%)	0.119
ALT(IU/L)	92.8±84.0	92.1±57.4	0.972
Naïve	60 (93.8%)	13 (72.2%)	0.021
Halted period (≥1 week)	) 27 (44.2%)	8 (44.4%)	0.864
Period (weeks)	3.4±3.3	2.2±1.4	0.318
Peginterferon dose
≥80%	56 (87.5%)	10 (55.6%)
＜80%	8 (12.5%)	8 (44.4%)	0.003
Ribavirin dose
≥80%	44 (68.8%)	7 (38.9%)
＜80%	20 (31.2%)	11 (61.1%)	0.021

SVR, sustained virologic response.

Table 4.

Multivariate Analysis for Factors Influencing SVR

		Multivariate analysis
		OR	95% CI	p-value
Genotype	Type 1	1
	Type non-1	2.86	0.82–9.95	0.098
Peginterferon dose	＜80%	1
	≥80%	4.92	1.14–21.22	0.033
Ribavirin dose	＜80%	1
	≥80%	2.12	0.55–8.18	0.272
Naïve	No	1
	Yes	8.4	1.52–46.20	0.014

SVR, sustained virologic response.

Table 5.

Peginterferon and Ribavirin Dose according to Treatment Periods

Treatment period	Dose of peginterferon			Dose of ribavirin
Treatment period	≥80%	80–60%	≤60%	≥80%	80–60%	≤60%
100–90%	66	6	0	50	15	7
90–80%	0	0	0	0	0	0
80–70%	0	1	0	0	1	0
70–60%	0	1	0	0	1	0
＜60%	0	0	8	0	0	8
p-value		0.00			0.00

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