We therefore conducted a large, pooled, post hoc analysis of patients with HCV genotypes 1, 4, 5, or 6 from four trials of PEG-IFN alfa-2a and ribavirin therapy to better understand the association between p38 MAPK signaling pathway virologic response and pharmacodynamic effects as reflected by changes in hematologic parameters and body weight. HCV, hepatitis C virus; IFN, interferon; PEG-IFN, pegylated interferon; SVR, sustained virologic response. Patients with HCV genotypes 1, 4, 5, or 6 receiving 24 or 48 weeks of combination therapy with PEG-IFN alfa-2a (Pegasys; Roche, Nutley, NJ; 180 μg/week) and ribavirin (Copegus; Roche, Nutley, NJ; 1,000 or 1,200 mg/day) were pooled from

two registration trials1, 2 and two phase 4 trials.7, 8 The registration trials were randomized, multicenter, phase 3 studies in IFN-naïve patients with chronic hepatitis C; the first trial compared the efficacy of PEG-IFN alfa-2a and ribavirin therapy with IFN alfa-2b and ribavirin therapy for 48 weeks,1 and the second trial of PEG-IFN alfa-2a and ribavirin click here therapy compared different treatment duration and ribavirin dose combinations.2 The phase 4 studies were noncomparative, open-label studies of PEG-IFN alfa-2a

and ribavirin for 48 weeks in treatment-naïve patients with HCV genotype 1; the majority (>73%) of patients in the first study were African American patients,7 and the second study was conducted in Latino and non-Latino Caucasian patients (ClinicalTrials.gov Identifier NCT00087607).8 All studies included stopping rules for nonresponse except for the trial in African American patients.7 Patients

who received PEG-IFN monotherapy medchemexpress or IFN alfa-2b and ribavirin combination therapy (Rebetron) and patients with HCV/human immunodeficiency coinfection were excluded from the study. The objectives of this study were: (1) to explore the association between pharmacodynamic parameters and virologic response category (SVR, relapse, breakthrough, and nonresponders); (2) to explore the association between pharmacodynamic parameters and race/ethnicity (African American, Latino Caucasians, non-Latino Caucasians, and other races); and (3) to evaluate the effects of clinically significant hemoglobin decline (>3 g/dL versus ≤3 g/dL) on SVR. The pharmacodynamic effects of interest in this analysis were hematologic parameters (hemoglobin level, neutrophil count, and platelet count) and weight loss. Maximum decrease (baseline value for the hematologic test minus the lowest value for that test while on therapy) was used to assess the change in hematologic parameters. To better adjust for the impact of baseline difference, percentage of change from baseline was used to analyze racial/ethnic group differences and body weight changes. For patients without the specified hematologic test or body weight measurement during treatment, the corresponding maximum decrease was set as missing.