Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals

Halina Michur; Phillip Morgan; Ivana Carey; Nigel Brown; Nigel Heaton; Michael Heneghan; Kosh Agarwal; John Michael Tredger

doi:doi:10.11648/j.ejcbs.20190503.13

Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals

Halina Michur, Phillip Morgan, Ivana Carey, Nigel Brown, Nigel Heaton, Michael Heneghan, Kosh Agarwal, John Michael Tredger

Published in European Journal of Clinical and Biomedical Sciences (Volume 5, Issue 3)

Received: 12 July 2019 Accepted: 20 August 2019 Published: 9 September 2019

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Abstract

In treating hepatitis C infection, identification of reliable markers predicting virological non-response appear central to improving outcome and to prompting changes in dynamic treatment approaches. The interrelationship of ribavirin (RBV) concentrations and laboratory variables with clinical outcomes was evaluated in HCV patients treated with ribavirin, and with or without early direct acting antivirals (DAA). Correlations between RBV concentration, laboratory variables (haemoglobin, absolute lymphocyte, platelet and neutrophil counts, serum creatinine and hepatitis C viral load) and patients’ characteristics associated with sustained virological response (SVR) were investigated using multivariate analysis. The 76 patients studied all received interferon (INF) and RBV, with 37 additionally given Boceprevir or Telaprevir. Significant correlations were noted between week 1 RBV concentration and subsequent total exposure at weeks 2, 4 and 12 (P < 0.0001). RBV concentrations in excess of 1.0 mg/L (week 1) and 2.0 mg/L (week 2) provided targets for avoiding breakthrough (P < 0.05). SVR was greater in patients without cirrhosis (73.3% vs. 41.3%; P < 0.01). All patients with an absolute haemoglobin (Hb) fall >30 g/L (week 8) experienced higher SVR rates (P < 0.03). RBV concentrations above 2.7 mg/L at week 4 or later increased the likelihood of Hb falls >30 g/L. Six factors were predictive of SVR in univariate analysis, and three in multivariate analysis. There is an association between SVR and absolute lymphocyte count, IL-28B CC genotype, and HCV-RNA load fall at week 1 (>80 %) or week 2 (>90 %) in HCV patients treated with INF/RBV and early DAA.

Published in	European Journal of Clinical and Biomedical Sciences (Volume 5, Issue 3)
DOI	10.11648/j.ejcbs.20190503.13
Page(s)	51-57
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Hepatitis C, Antiviral Therapy, Direct-acting Antivirals, Ribavirin, Cirrhosis

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APA Style

Halina Michur, Phillip Morgan, Ivana Carey, Nigel Brown, Nigel Heaton, et al. (2019). Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals. European Journal of Clinical and Biomedical Sciences, 5(3), 51-57. https://doi.org/10.11648/j.ejcbs.20190503.13

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ACS Style

Halina Michur; Phillip Morgan; Ivana Carey; Nigel Brown; Nigel Heaton, et al. Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals. Eur. J. Clin. Biomed. Sci. 2019, 5(3), 51-57. doi: 10.11648/j.ejcbs.20190503.13

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AMA Style

Halina Michur, Phillip Morgan, Ivana Carey, Nigel Brown, Nigel Heaton, et al. Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals. Eur J Clin Biomed Sci. 2019;5(3):51-57. doi: 10.11648/j.ejcbs.20190503.13

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@article{10.11648/j.ejcbs.20190503.13,
  author = {Halina Michur and Phillip Morgan and Ivana Carey and Nigel Brown and Nigel Heaton and Michael Heneghan and Kosh Agarwal and John Michael Tredger},
  title = {Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals},
  journal = {European Journal of Clinical and Biomedical Sciences},
  volume = {5},
  number = {3},
  pages = {51-57},
  doi = {10.11648/j.ejcbs.20190503.13},
  url = {https://doi.org/10.11648/j.ejcbs.20190503.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20190503.13},
  abstract = {In treating hepatitis C infection, identification of reliable markers predicting virological non-response appear central to improving outcome and to prompting changes in dynamic treatment approaches. The interrelationship of ribavirin (RBV) concentrations and laboratory variables with clinical outcomes was evaluated in HCV patients treated with ribavirin, and with or without early direct acting antivirals (DAA). Correlations between RBV concentration, laboratory variables (haemoglobin, absolute lymphocyte, platelet and neutrophil counts, serum creatinine and hepatitis C viral load) and patients’ characteristics associated with sustained virological response (SVR) were investigated using multivariate analysis. The 76 patients studied all received interferon (INF) and RBV, with 37 additionally given Boceprevir or Telaprevir. Significant correlations were noted between week 1 RBV concentration and subsequent total exposure at weeks 2, 4 and 12 (P P P 30 g/L (week 8) experienced higher SVR rates (P 30 g/L. Six factors were predictive of SVR in univariate analysis, and three in multivariate analysis. There is an association between SVR and absolute lymphocyte count, IL-28B CC genotype, and HCV-RNA load fall at week 1 (>80 %) or week 2 (>90 %) in HCV patients treated with INF/RBV and early DAA.},
 year = {2019}
}

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TY  - JOUR
T1  - Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals
AU  - Halina Michur
AU  - Phillip Morgan
AU  - Ivana Carey
AU  - Nigel Brown
AU  - Nigel Heaton
AU  - Michael Heneghan
AU  - Kosh Agarwal
AU  - John Michael Tredger
Y1  - 2019/09/09
PY  - 2019
N1  - https://doi.org/10.11648/j.ejcbs.20190503.13
DO  - 10.11648/j.ejcbs.20190503.13
T2  - European Journal of Clinical and Biomedical Sciences
JF  - European Journal of Clinical and Biomedical Sciences
JO  - European Journal of Clinical and Biomedical Sciences
SP  - 51
EP  - 57
PB  - Science Publishing Group
SN  - 2575-5005
UR  - https://doi.org/10.11648/j.ejcbs.20190503.13
AB  - In treating hepatitis C infection, identification of reliable markers predicting virological non-response appear central to improving outcome and to prompting changes in dynamic treatment approaches. The interrelationship of ribavirin (RBV) concentrations and laboratory variables with clinical outcomes was evaluated in HCV patients treated with ribavirin, and with or without early direct acting antivirals (DAA). Correlations between RBV concentration, laboratory variables (haemoglobin, absolute lymphocyte, platelet and neutrophil counts, serum creatinine and hepatitis C viral load) and patients’ characteristics associated with sustained virological response (SVR) were investigated using multivariate analysis. The 76 patients studied all received interferon (INF) and RBV, with 37 additionally given Boceprevir or Telaprevir. Significant correlations were noted between week 1 RBV concentration and subsequent total exposure at weeks 2, 4 and 12 (P P P 30 g/L (week 8) experienced higher SVR rates (P 30 g/L. Six factors were predictive of SVR in univariate analysis, and three in multivariate analysis. There is an association between SVR and absolute lymphocyte count, IL-28B CC genotype, and HCV-RNA load fall at week 1 (>80 %) or week 2 (>90 %) in HCV patients treated with INF/RBV and early DAA.
VL  - 5
IS  - 3
ER  -

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Author Information

Halina Michur

Institute of Liver Studies, King’s College Hospital, London, UK
Phillip Morgan

Institute of Liver Studies, King’s College Hospital, London, UK
Ivana Carey

Institute of Liver Studies, King’s College Hospital, London, UK
Nigel Brown

Department of Clinical Chemistry, Wansbeck General Hospital, Ashington, UK
Nigel Heaton

Institute of Liver Studies, King’s College Hospital, London, UK
Michael Heneghan

Institute of Liver Studies, King’s College Hospital, London, UK
Kosh Agarwal

Institute of Liver Studies, King’s College Hospital, London, UK
John Michael Tredger

Institute of Liver Studies, King’s College Hospital, London, UK

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APA Style

Halina Michur, Phillip Morgan, Ivana Carey, Nigel Brown, Nigel Heaton, et al. (2019). Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals. European Journal of Clinical and Biomedical Sciences, 5(3), 51-57. https://doi.org/10.11648/j.ejcbs.20190503.13

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ACS Style

Halina Michur; Phillip Morgan; Ivana Carey; Nigel Brown; Nigel Heaton, et al. Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals. Eur. J. Clin. Biomed. Sci. 2019, 5(3), 51-57. doi: 10.11648/j.ejcbs.20190503.13

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AMA Style

Halina Michur, Phillip Morgan, Ivana Carey, Nigel Brown, Nigel Heaton, et al. Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals. Eur J Clin Biomed Sci. 2019;5(3):51-57. doi: 10.11648/j.ejcbs.20190503.13

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@article{10.11648/j.ejcbs.20190503.13,
  author = {Halina Michur and Phillip Morgan and Ivana Carey and Nigel Brown and Nigel Heaton and Michael Heneghan and Kosh Agarwal and John Michael Tredger},
  title = {Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals},
  journal = {European Journal of Clinical and Biomedical Sciences},
  volume = {5},
  number = {3},
  pages = {51-57},
  doi = {10.11648/j.ejcbs.20190503.13},
  url = {https://doi.org/10.11648/j.ejcbs.20190503.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejcbs.20190503.13},
  abstract = {In treating hepatitis C infection, identification of reliable markers predicting virological non-response appear central to improving outcome and to prompting changes in dynamic treatment approaches. The interrelationship of ribavirin (RBV) concentrations and laboratory variables with clinical outcomes was evaluated in HCV patients treated with ribavirin, and with or without early direct acting antivirals (DAA). Correlations between RBV concentration, laboratory variables (haemoglobin, absolute lymphocyte, platelet and neutrophil counts, serum creatinine and hepatitis C viral load) and patients’ characteristics associated with sustained virological response (SVR) were investigated using multivariate analysis. The 76 patients studied all received interferon (INF) and RBV, with 37 additionally given Boceprevir or Telaprevir. Significant correlations were noted between week 1 RBV concentration and subsequent total exposure at weeks 2, 4 and 12 (P P P 30 g/L (week 8) experienced higher SVR rates (P 30 g/L. Six factors were predictive of SVR in univariate analysis, and three in multivariate analysis. There is an association between SVR and absolute lymphocyte count, IL-28B CC genotype, and HCV-RNA load fall at week 1 (>80 %) or week 2 (>90 %) in HCV patients treated with INF/RBV and early DAA.},
 year = {2019}
}

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TY  - JOUR
T1  - Ribavirin Concentrations, Laboratory Variables, and Clinical Outcomes During Treatment of Hepatitis C Infection with First Generation Direct-Acting Antivirals
AU  - Halina Michur
AU  - Phillip Morgan
AU  - Ivana Carey
AU  - Nigel Brown
AU  - Nigel Heaton
AU  - Michael Heneghan
AU  - Kosh Agarwal
AU  - John Michael Tredger
Y1  - 2019/09/09
PY  - 2019
N1  - https://doi.org/10.11648/j.ejcbs.20190503.13
DO  - 10.11648/j.ejcbs.20190503.13
T2  - European Journal of Clinical and Biomedical Sciences
JF  - European Journal of Clinical and Biomedical Sciences
JO  - European Journal of Clinical and Biomedical Sciences
SP  - 51
EP  - 57
PB  - Science Publishing Group
SN  - 2575-5005
UR  - https://doi.org/10.11648/j.ejcbs.20190503.13
AB  - In treating hepatitis C infection, identification of reliable markers predicting virological non-response appear central to improving outcome and to prompting changes in dynamic treatment approaches. The interrelationship of ribavirin (RBV) concentrations and laboratory variables with clinical outcomes was evaluated in HCV patients treated with ribavirin, and with or without early direct acting antivirals (DAA). Correlations between RBV concentration, laboratory variables (haemoglobin, absolute lymphocyte, platelet and neutrophil counts, serum creatinine and hepatitis C viral load) and patients’ characteristics associated with sustained virological response (SVR) were investigated using multivariate analysis. The 76 patients studied all received interferon (INF) and RBV, with 37 additionally given Boceprevir or Telaprevir. Significant correlations were noted between week 1 RBV concentration and subsequent total exposure at weeks 2, 4 and 12 (P P P 30 g/L (week 8) experienced higher SVR rates (P 30 g/L. Six factors were predictive of SVR in univariate analysis, and three in multivariate analysis. There is an association between SVR and absolute lymphocyte count, IL-28B CC genotype, and HCV-RNA load fall at week 1 (>80 %) or week 2 (>90 %) in HCV patients treated with INF/RBV and early DAA.
VL  - 5
IS  - 3
ER  -

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