Pharmacodynamics of PEG-IFN α differentiate HIV/HCV coinfected sustained virological responders from nonresponders

Abstract

Pegylated interferon (PEG-IFN) has become standard therapy for hepatitis C virus (HCV) infection. We evaluated whether PEG-IFN pharmacodynamics and pharmacokinetics account for differences in treatment outcome and whether these parameters might be predictors of therapeutic outcome. Twenty-four IFN-naïve, HCV/human immunodeficiency virus–coinfected patients received PEG-IFN α-2b (1.5 μg/kg) once weekly plus daily ribavirin (1,000 or 1,200 mg) for up to 48 weeks. HCV RNA and PEG-IFN α concentrations were obtained from samples collected frequently after the first 3 PEG-IFN doses. We modeled HCV kinetics incorporating pharmacokinetic and pharmacodynamic parameters. Although PEG-IFN concentrations and pharmacokinetic parameters were similar in sustained virological responders (SVRs) and nonresponders (NRs), the PEG-IFN α-2b concentration that decreases HCV production by 50% (EC₅₀) was lower in SVRs compared with NRs (0.04 vs. 0.45 μg/L [P = .014]). Additionally, the median therapeutic quotient (i.e., the ratio between average PEG-IFN concentration and EC₅₀[C̄/EC₅₀]), and the PEG-IFN concentration at day 7 divided by EC₅₀ (C(7)/EC₅₀) were significantly increased in SVRs compared with NRs after the first (10.1 vs. 1.0 [P = .012], 2.8 vs. 0.3 [P = .007], respectively) and second (14.0 vs. 1.1 [P = .016], 5.4 vs. 0.4 [P = .02], respectively) PEG-IFN doses. All 3 parameters may be used to identify NRs. In conclusion, PEG-IFN concentrations and pharmacokinetic parameters do not differ between SVRs and NRs. In contrast, pharmacodynamic measurements—namely EC_50, the therapeutic quotient, and C(7)/EC₅₀—are different in coinfected SVRs and NRs. These parameters might be useful predictors of treatment outcome during the first month of therapy. (HEPATOLOGY 2006;43:943–953.)