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Background Race has been shown to be a factor in the response to therapy for hepatitis C virus (HCV) infection, and limited data suggest that ethnic group may be as well; however, Latinos and other ethnic subpopulations have been underrepresented in clinical trials. We evaluated the effect of Latino ethnic background on the response to treatment with peginterferon alfa-2a and ribavirin in patients infected with HCV genotype 1 who had not been treated previously.
Methods In a multicenter, open-label, nonrandomized, prospective study, 269 Latino and 300 non-Latino whites with HCV infection received peginterferon alfa-2a, at a dose of 180 µg per week, and ribavirin, at a dose of 1000 or 1200 mg per day, for 48 weeks, and were followed through 72 weeks. The primary end point was a sustained virologic response. We enrolled Latinos whose parents and grandparents spoke Spanish as their primary language; nonwhite Latinos were excluded.
Results Baseline characteristics were similar in the Latino and non-Latino groups, although higher proportions of Latino patients were 40 years of age or younger, had a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of more than 27 or more than 30, and had cirrhosis. The rate of sustained virologic response was higher among non-Latino whites than among Latinos (49% vs. 34%, P<0.001). The absence of HCV RNA in serum was more frequent in non-Latino whites at week 4 (P=0.045) and throughout the treatment period (P<0.001 for all other comparisons). Latino or non-Latino background was an independent predictor of the rate of sustained virologic response in an analysis adjusted for baseline differences in BMI, cirrhosis, and other characteristics. Adherence to treatment did not differ significantly between the two groups. The numbers of patients with adverse events and dose modifications were similar in the two groups, but fewer Latino patients discontinued therapy because of adverse events.
Conclusions Treatment with peginterferon alfa-2a and ribavirin for 48 weeks resulted in rates of sustained virologic response among patients infected with HCV genotype 1 that were lower among Latino whites than among non-Latino whites. Strategies to improve the sustained virologic response in Latinos are needed. (ClinicalTrials.gov number, NCT00107653
[ClinicalTrials.gov]
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Source Information
From Fundacion de Investigacion de Diego, San Juan, and the Ponce School of Medicine, Ponce — both in Puerto Rico (M.R.-T.); the Miller School of Medicine, University of Miami, Miami (L.J.J., P.M.); the University of California, San Francisco, Fresno Medical Education Program, Community Regional Medical Center, Fresno (M.Y.S.); the University of California–Davis Medical Center, Sacramento (L.R.); the University of Texas Medical School and St. Luke's Episcopal Hospital Center for Liver Disease, Houston (V.A.-S.); and Roche, Nutley, NJ (F.M.H., P.M.).
Address reprint requests to Dr. Rodriguez-Torres at Fundacion de Investigacion de Diego, Ave. de Diego 359, Suite 302, San Juan, Puerto Rico 00909, or at rodztorres{at}coqui.net.
Related Letters:
Peginterferon Alfa-2a and Ribavirin in Latino and Non-Latino Whites with Hepatitis C
Malgarini R. B., Pimpinella G., Schildgen O., Rodriguez-Torres M., Hamzeh F.
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N Engl J Med 2009;
360:1907-1908, Apr 30, 2009.
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