Z Gastroenterol 2013; 51 - P_5_48
DOI: 10.1055/s-0032-1332162

Thyroid dysfunction induced by Peginterferon alfa-2B (PEG-2B)/Ribavirin (RBV) is a favorable predictor of SVR in patients with HCV genotype 1 (G1), but not HCV genotype 2/3 (G2/3) infection

S Mauss 1, D Hüppe 2, E Zehnter 3, MP Manns 4, G Teuber 5, T Dahhan 6, U Meyer 7, T Witthöft 8, B Möller 9, N Dikopoulos 10, J Brack 11, B Stade 12, M Bilzer 12
  • 1Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
  • 2Medical Group Practice, Herne, Germany
  • 3Gastroenterological Practice, Dortmund, Germany
  • 4Medical School of Hannover, Hannover, Germany
  • 5Johann Wolfgang Goethe University, Frankfurt, Germany
  • 6Medical Practice, Fellbach, Germany
  • 7Medical Practice, Berlin, Germany
  • 8Gastroenterological Practice, Stade, Germany
  • 9Medical Practice, Berlin, Germany
  • 10Gesundheitszentrum Langenau, Langenau, Germany
  • 11Hospital Nord Ochsenzoll, Hamburg, Germany
  • 12MSD Pharma GmbH, Haar, Germany

Background: Thyroiditis leading to thyroid dysfunction in patients undergoing treatment for chronic HCV infection has been attributed to interferon-stimulated immune mechanisms similar to that implicated in the antiviral response induced by interferons. Here, the possible association between thyroid dysfunction related to Peg2b/RBV and the virologic outcome of patients treated for G1 and G2/3 infection was investigated.

Methods: Data from patients treated for G1 (N=1923), G2 (N=250) and G3 (N=1117) infection with Peg2b 1.5µg/kg/week + weight-based RBV (800–1200mg/day) for up to 48 weeks in a large observational real-life study at 285 sites in Germany were retrospectively analyzed. Thyroid dysfunction was estimated by serum TSH levels. TSH levels below or above the normal range were classified as abnormal.

Results: 1436 patients with G1 infection had normal TSH levels at baseline and at least one TSH measurement during therapy. After starting treatment abnormal TSH values became apparent in 304 patients (21.2%). Significantly higher SVR rates were achieved by patients with abnormal than by patients with normal TSH values (44.0% vs. 53.6%) while non-response rates were significantly lower (34.9% vs. 24.7%, p=0.007). This effect was more pronounced in “difficult-to-treat” patients with high baseline viral load and age >50 years. Multivariate logistic regression analysis including gender, viral load, age and platelet count identified abnormal TSH as independent factor associated with SVR (OR=1.4; p=0.0124) in G1 infection. From 1035 patients with G2/3 infection and normal TSH levels at baseline 197 patients (19.0%) showed abnormal TSH values during treatment. Interestingly, abnormal TSH levels were not associated with improved SVR rates in patients with G2/3 infection.

Conclusions: Thyroid dysfunction triggered during Peg2b/RBV treatment of HCV infection is a favorable independent factor predicting high SVR and low non-response rates in patients with HCV G1 infection, but not HCV G2/3 infection.