Patient education improves adherence to peg-interferon and ribavirin in chronic genotype 2 or 3 hepatitis C virus infection: a prospective, real-life, observational study

Abstract

Aim: To evaluate the impact of therapeutic education on adherence to antiviral treatment and sustained virological response (SVR) in a real-life setting in genotype 2/3 hepatitis C, as there are few adherence data in genotype 2/3 infection, even from randomized trials.

Methods: This prospective survey included genotype 2/3 patients who received peg-interferon alfa-2b and ribavirin. There was no intervention. Adherence was self-reported over the past 4 wk (peg-interferon) or 7 d (ribavirin). Adherence to bitherapy was defined as adherence to the two drugs for >or= 20 wk. SVR was defined as undetectable RNA >or= 12 wk after the end of treatment.

Results: 370/674 patients received education during the first 3 mo of treatment. After 6 mo, adherence to bitherapy was higher in educated patients (61% vs 47%, P = 0.01). Adherence to peg-interferon was 78% vs 69% (P = 0.06). Adherence to ribavirin was 70% vs 56% (P = 0.006). The SVR (77% vs 70%, P = 0.05) and relapse (10% vs 16%, P = 0.09) rates tended to be improved. After adjustment for baseline differences, education improved adherence [Odds ratio (OR) 1.58, P = 0.04] but not the SVR (OR 1.54, P = 0.06).

Conclusion: In genotype 2/3 patients, therapeutic education helped maintain real-life adherence to bitherapy.

Figure 1

Patient flow.

Figure 2

Impact of patient therapeutic education on adherence to treatment (A and B) and virological response (C). At 3 mo of treatment, the proportion of patients adhering to treatment (patient self-report) was similar in the two groups. At 6 mo, the proportion of adherents dropped in patients without therapeutic education only. The virological response was better in educated patients, with an increased rate of SVR and a lower relapse rate.

Figure 3

Virological response in patients infected with genotype 2 (A) or genotype 3 (B), and according to viral load (> or ≤ 800 000 IU/mL). Although not statistically significant, patient therapeutic education was beneficial in all patient subgroups, especially in those with genotype 2 and low viral load, with a marked impact on the SVR (SVR, P = 0.038) and relapse (P = 0.047) rates.