[Is chronic hepatitis C treatment as efficient in the general population as in randomised trials?]. / Le traitement de l'hépatite chronique C est-il aussi efficace dans la population générale que dans les essais randomisés?

ABSTRACT

AIMS: The aim of this population-based study was to determine the effectiveness of antiviral therapy in non selected chronic hepatitis C patients. METHODS: The study was performed in all new patients with anti-HCV antibodies who had registered in a specialised viral hepatitis registry since 1994 and who lived in the French departments of Côte-d'Or and Doubs (1 005 817 inhabitants). RESULTS: 1251 of the 1508 recorded cases were studied; 262 were treated. Results of treatment were available in 238 cases, 157 were treated with interferon alone and 81 with interferon + ribavirine. Sustained virological response was observed in 18% of cases after interferon alone and 46.9% after interferon + ribavirine. In multivariate analysis, age under 40 and combined therapy were positively correlated to sustained virological response. Premature treatment discontinuation was associated with a lack of sustained response which was unrelated to gender or liver fibrosis. Fifty seven patients received combined therapy after unsuccessful monotherapy sustained virological response rates were 33.3% in responders-relapsers and 23.7% in non-responders to initial therapy. CONCLUSIONS: This study showed that sustained response rates were similar in non selected patients from the general population and in highly selected patients from randomised trials. These results emphasize the necessity of increasing the ratio of treated patients which is still too low in general population.