Session Title: Category 5g. VIRAL HEPATITIS: g. HEPATITIS C - CLINICAL (THERAPY)
Presentation Date: Apr 15, 2010
LIPID MODULATORS (STATINS AND EICOSAPENTAENOIC ACID) ACCELERATE THE DECLINE OF HCV VIRUS LOAD DURING TREATMENT WITH PEG-INTERFERON AND RIBAVIRIN
M. Nakamuta1*, T. Yoshimoto1, S. Harada1, T. Ohashi1, N. Fukushima1, K. Fukuizumi1, T. Fujino1, H. Nishi1, T. Mizutani1, N. Harada1, H. Nomura2, M. Enjoji3
1Gastroenterology, Clinical Research Center, Kyushu Medical Center, National Hospital Organization, Fukuoka, 2Department of Gastroenterology, Shin-Kokura Hospital, Kitakyushu, 3Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan. *email@example.com
Background: HCV is strongly associated with lipids during its lifecycle, exploiting lipid metabolism by accelerating cholesterol and fatty acid synthesis in the HCV-infected liver, as we previously reported. Lipid modulators such as statins or eicosapentaenoic acid (EPA) were shown to suppress HCV replication in vitro. These findings suggest that lipid modulators, which suppress lipid synthesis, could ameliorate HCV proliferation, and may enhance the efficacy of current peg-interferon (IFN) + ribavirin (RBV) treatment.
Methods: Patients with high viral loads (>5.0 IUlog/ml based on Cobas TaqMan real-time PCR assay) have been treated with pitavastatin (2 mg/d) and EPA (1800 mg/d) in addition to standard therapy with peg-IFNa2b + ribavirin (RBV) since 2008. We compared the early virological response (EVR), rapid virological response (RVR) and sustained virological response (SVR) between patients treated with lipid modulators versus patients treated without them in 2007. HCV RNA-negative blood was defined as a viral load < 1.7 IUlog/ml or negative results for the Cobas Amplicor test (< 15 IU/ml).
Results: In patients with genotype 1b, lipid modulators increased EVR from 53% (27/52) to 68% (54/79). Lipid modulators increased the HCV RNA-negative rate at week 48 of treatment from 79% (30/38) to 90% (18/20). In patients with genotype 2a or 2b, lipid modulators increased RVR and SVR from 54% (13/24) and 75% (18/24) to 82% (40/49) and 88% (14/16), respectively.
Conclusion: These results indicate that the lipid modulators pitavastatin and EPA could enhance the efficacy of peg-IFN and RBV therapy.