P1113 CHOLESTEROL METABOLISM DURING PEG-IFN + RBV + TVR TREATMENT

Background: HCV-6 is common in patients from Southeast Asia and the surrounding regions where HCV prevalence can be up to 6%. Optimal treatment duration for HCV-6 is unknown given inconclusive evidence from studies with varying methodologies and small sample sizes. Our goal was to assess the optimal treatment duration for these patients. Methods: We performed a literature search for ‘genotype 6' in the MEDLINE and EMBASE databases (without MEDLINE-indexed articles) in September 2013, which produced 161 and 251 articles, respectively. Additional abstracts were identified from four major international GI/ liver conferences in 2012 and 2013. Inclusion criteria were: original study, treatment-naive patients, and minimum sample size ( ≥10 HCV-6 patients). Exclusion criteria were: coinfections with hepatitis B virus, HIV, other HCV genotypes, and/or other liver diseases. Only patients who received PEG IFN+RBV were included in the analysis. All literature searches and data extraction were performed independently by two authors. Primary outcome was pooled sustained virologic response (SVR, undetectable HCV RNA PCR 24 weeks after end of therapy). Cochrane Q-test (p-value of 0.10) and I-squared statistic (> 50%) were utilized to assess heterogeneity. Results: A total of 13 studies with 641 patients were included in the analysis. Pooled SVR estimate, by random effects model (Q-value=38.4, p-value <0.001; I-squared=68.7%), was 77% (CI=70-83%) for all patients and 79% (CI=73-84%) and 59% (CI=46-70%) for 48-week group and for 24-week group, respectively. In studies with direct comparison of the two groups, SVR was superior in patients treated for 48 vs. 24 weeks, OR 1.9 (CI=1.08-3.2, p=0.026) (Figure 1). In studies with direct comparison and intention-to-treat analysis only, there was a trend for higher SVR in patients treated for 48 vs. 24 weeks, OR 1.63 (CI=0.91-2.92, p=0.10) (Figure 2). SVR in patients with rapid virologic response (RVR, undetectable HCV RNA PCR after 4 weeks of therapy) treated for 48 weeks and 24 weeks was 86.1% (CI=77.5-91.8%) and 77.6% (CI=63.1-87.5%), respectively. Those with RVR had better treatment response than those without RVR: OR 18.33 (CI= 5.67-59.26, p<0.001) for the 48-week group and OR 18.61 (CI=2.51-137.91, p=0.004) for the 24-week group. When directly compared, there was no statistical significance in SVR in patients with RVR treated for 48 or 24 weeks, OR 1.74 (CI=0.65-4.64, p=0.271). Conclusions: Patients treated for 48 weeks had higher SVR than those treated for 24 weeks (79% vs. 59%, respectively); however, patients with RVR appear to have similar treatment responses regardless of treatment duration. HCV-6 patients treated with PEG IFN+RBV should be treated for 24 weeks if there is RVR and 48 weeks if not.