Análisis mediante curvas ROC de los factores predictivos de respuesta al tratamiento con interferón más ribavirina en pacientes con hepatitis crónica C en recaída tras un tratamiento previo con interferón.

Autores de IIS La Fe

• Vicente Olaso Peiro

  Autor

• Juan Ginés Córdoba Cortijo

  Autor

• José Miguel Molina Moreno

  Autor

• Berta López Montesinos

  Autor

• Emilio Monte Boquet

  Autor

• Felix Calvo Hernan

  Autor

• Belén Beltrán Niclós

  Autor

• Blanca Martínez De Las Heras

  Autor

Participantes ajenos a IIS La Fe

• Siles MS
• Bau I
• Gobernado M

Abstract

This study aimed to identify the factors predictive of response before the initiation of treatment and throughout the treatment period in patients with chronic hepatitis C relapse after treatment with interferon-a who were retreated with a standard regimen of interferon-a plus ribavirine and followed up for 40 months. Forty-four patients (40 with genotype 1, four without genotype 1) were included in the study. Four patients (genotype 1) were excluded because of adverse effects. The rate of maintained response was 55% (50% genotype 1, 100% non-genotype 1). The stage of histological damage (>2), glutamic-pyruvic transaminase (GPT) concentration (< or = 26 UI/l) and the association between the GPT concentration and the detection of the RNA-HCV in the first and third treatment months were the variables with an area under the ROC curve and a confidence interval >0.5. The probability of predicting a maintained response (negative predictive value) if the stage of histological lesion was <2 was 62.9%, while the positive predictive value was 100%. During the treatment, the disappearance of the RNA-HCV together with GPT values < or =26 in the first treatment month were the best predictive values. In this case, the negative predictive value was 78.3% and the positive predictive value was 76.5% (OR: 11.7, 2.6-52.2). Furthermore, the GPT value with the best predictive value (<26 UI/l) was a more effective predictor of the response to treatment than the normal value of the GPT. Finally, the GPT values >26 UI/l and the detection of RNA/HCV in the first or third treatment month were certain predictors of the absence of response but with low sensitivity (10-12%). It was concluded that is possible to predict the response to the combined treatment with an acceptable level of confidence, although not unequivocally. Ninety percent of the patients would be candidates for maintaining treatment for at least 6-12 months, while approximately 10% could undergo early interruption of treatment due to the absence of response.