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Pegasys Combination Therapy Approved for Dually Infected Patients With HIV and Hepatitis C
“Roche is proud to have delivered the ground breaking research work that has led to the approval of Pegasys (peginterferon alfa-2a (40KD)) and Copegus (ribavirin) for the treatment of chronic hepatitis C in patients with HIV-HCV co-infection in the US, and recently in Europe. Pegasys and Copegus bring a much needed treatment option for patients with both HCV and HIV, a devastating disease combination.” said William M. Burns, CEO of Roche’s Pharmaceutical Division. “Roche has a strong heritage of developing anti-viral medications and the recent approvals worldwide further reinforce our commitment to finding innovative solutions for hepatitis patients.”
Co-infection has emerged as a major public health concern with data suggesting that globally about 30% of HIV-infected patients are co-infected with HCV. Hepatitis C and HIV are the two most prevalent blood-borne infections in the United States.
“For the first time, the 300,000 Americans who are co-infected with hepatitis C and HIV have an approved hepatitis C treatment option. This is a very important advance for the HIV community,” said Jeffrey Smith, Director, Clinical Research, American Foundation for AIDS Research (amfAR). “Hepatitis C has become one of the leading killers of people with HIV because the disease progresses much more quickly to liver failure in people who are co-infected with HIV.”
Pegasys is a highly effective hepatitis medication which has become the most prescribed hepatitis C medication in the US. It was approved in 2002 by the FDA for use alone and in combination with Copegus for the treatment of adults with chronic hepatitis C. This new FDA approval for Pegasys follows a recent flurry of approvals by the European Commission including treatment of chronic hepatitis C in patients co-infected with hepatitis C and HIV, the treatment of hepatitis C patients with persistently ‘normal’ liver enzymes, as well as several approvals worldwide for Pegasys in the treatment of chronic hepatitis B. Additional milestones are expected for this leading hepatitis treatment throughout 2005.
About the study
The FDA and recent European Commission approval of Pegasys combination therapy for the treatment of HCV-HIV co-infected patients are based on results from the AIDS Pegasys Ribavirin International CO-infection Trial (APRICOT), the largest-ever study evaluating chronic hepatitis C treatment in patients co-infected with HIV and HCV. APRICOT is one of six Pegasys studies published in the New England Journal of Medicine1.
According to Dr. Francesca Torriani, Associate Professor of Medicine, Antiviral Research Centre, University of California and the lead author of the APRICOT study, “It is clearly important that we successfully treat these patients as we now know that, in HIV-HCV co-infected patients, liver disease due to hepatitis C is the leading cause of death and hospitalization. With so much improvement in patient’s quality of life and survival thanks to potent antiretroviral therapy, the HIV community and providers don’t want to see those benefits disappear by the emergence of fatal liver disease.”
Investigators randomized 868 patients from 19 countries into APRICOT. Patients co-infected with HIV-HCV were randomized to receive either Pegasys 180 mcg once weekly plus Copegus 800 mg daily; Pegasys 180 mcg monotherapy once weekly (plus placebo), or conventional interferon alfa-2a (Roferon A) 3MIU three times a week in combination with Copegus 800 mg daily, all for 48 weeks.
The key results of APRICOT were:
* 40% of patients treated with Pegasys plus ribavirin achieved a sustained virological response (SVR, which is indicative of a cure) compared with 20% of patients treated with Pegasys monotherapy and 12% of patients treated with conventional interferon/ribavirin.
* Genotype 1 patients, those with the most difficult to treat type of the virus, treated with Pegasys plus ribavirin achieved a four-fold increase in SVR compared with conventional interferon/ribavirin (29% vs 7%).
* 62% of genotype 2/3 patients treated with Pegasys plus ribavirin combination therapy achieved an SVR compared to 20% with conventional interferon/ribavirin.
* Pegasys plus ribavirin therapy effectively treated hepatitis C in patients with HIV-HCV co-infection being compatible with antiviral treatment and had a positive effect on the virological control of HIV infection.
* In APRICOT, treatment with Pegasys plus ribavirin was associated with the greatest overall histological improvement, even in patients who do not achieve an SVR.
Pegasys, the market leader worldwide in hepatitis C therapy, provides significant benefit over conventional combination interferon therapy in HCV patients of all genotypes. The benefits of Pegasys are derived from its large 40 kilodalton (KD) branched-chain polyethylene glycol (PEG) construction, which allows for sustained drug levels over the course of a full week. Pegasys also distributes more readily to the liver (the primary site of infection) than conventional interferon. Pegasys is the only pegylated interferon available as a ready-to-administer solution. Each weekly subcutaneous injection contains 180 mcg of pegylated interferon alfa-2a (40KD), which is the approved dose for all patients, regardless of body weight.
1. Torriani FJ et al. Peginterferon Alfa-2a plus Ribavirin for Chronic Hepatitis c Virus Infection in HIV-Infected Patients. N Engl. J Med. 2204;351(5): 438-450.