The impact of interferon plus ribavirin on response to therapy in black patients with chronic hepatitis C

Background & Aims: Black patients with chronic hepatitis C have lower respo nse rates than white patients to interferon monotherapy. The factors respon sible for these differences are unknown, as is the impact of combination an tiviral therapy on responsiveness among ethnic groups. We evaluated the imp act of race on response to therapy in these patients. Methods: A total of 1 744 patients with chronic hepatitis C were randomized in 2 recent clinical trials to receive 24 dr 48 weeks of interferon monotherapy or interferon-ri bavirin combination therapy. Results: Sustained virologic responses occurre d in 27% of 1600 whites, 11% of 53 blacks (P = 0.01 vs. white), 44% of 32 A sians, and 16% of 27 Hispanics. No black patient had a sustained virologic response to interferon monotherapy, but 20% and 23% had sustained responses to 24 and 48 weeks, respectively, of combination therapy. Among black pati ents, 96% had hepatitis C genotype 1 compared with 65% of white subjects (P < 0.0001). Sustained response rates were similar for black and white patie nts with genotype 1 infection (23% vs. 22%, respectively). Compared with wh ites, black patients were older, weighed more, and had higher median Histol ogic Activity Index scores but did not differ in sex, baseline alanine amin otransferase or hepatitis C virus (HCV)-RNA levels, degree of fibrosis or p ercentage with cirrhosis, or other demographic variables. White subjects ha d a significantly greater reduction in HCV-RNA levels than blacks at weeks 4, 12, 24, and 48 of therapy, but only for black patients treated with inte rferon monotherapy. The decreased reduction of HCV-RNA reduction among blac ks was eliminated by combination therapy. Conclusions: These observations s uggest that the impaired responsiveness of black patients to interferon mon otherapy can be overcome partially by combination interferon-ribavirin ther apy.