Lead-in treatment with interferon-β/ribavirin may modify the early hepatitis C virus dynamics in pegylated interferon alpha-2b/ribavirin combination for chronic hepatitis C patients with the IL28B minor genotype

Background and Aim The most important factor influencing the effect of pegylated interferon (PEG-IFN)/ribavirin therapy (PEG) for chronic hepatitis C genotype 1b with high viral load is the interleukin 28B (IL28B) genotype. We investigated the usefulness of lead-in twice-daily interferon (IFN)-β/ribavirin therapy (IFN-β), and the early hepatitis C virus RNA (HCV-RNA) dynamics was compared between PEG and IFN-β groups according to the IL28B genotype. Methods Forty-six patients were randomly allocated to PEG and IFN-β groups, and HCV-RNA dynamics in an early phase of treatment were analyzed. Results The patients with minor IL28B genotype was 6/23 and 8/23 in IFN-β and PEG groups, respectively. In the patients with IL28B major genotype, viral load reduction was marginally greater in IFN-β group than in PEG group. In contrast, in the patients with the IL28B minor genotype, viral load reduction was significantly and numerically greater in IFN-β group than in PEG group at 1 week (2.07 vs 0.76 log IU/mL, P = 0.038), 2 weeks (2.73 vs 1.01, P = 0.009), 4 weeks (2.72 vs 1.55, P = 0.059), and 12 weeks (4.56 vs 3.24, P = 0.104). The sustained virological response rates in the IL28B major genotype were similar between IFN-β group (47.1%, 8/17) and PEG group (53.3%, 8/15). In contrast, the sustained virological response rates in the IL28B minor genotype were numerically higher in IFN-β group (50.0%, 3/6) than in PEG group (12.5%, 1/8), although not statistically significant. Conclusion It was suggested that lead-in twice-daily IFN-β/ribavirin treatment followed by PEG-IFN/ribavirin combination therapy may modify the HCV-RNA dynamics compared with that by PEG-IFN/ribavirin therapy, and it is particularly useful for the IL28B minor genotype.