Vitamin B12 supplementation improves rates of sustained viral response in patients chronically infected with hepatitis C virus
Rocco A et al. – Vitamin B12 supplementation significantly improves sustained viral response (SVR) rates in hepatitis C virus (HCV)–infected patients naïve to antiviral therapy.Methods
- Ninety–four patients with chronic HCV hepatitis were randomly assigned to receive pegylated interferon α plus ribavirin (standard–of–care; SOC) or SOC plus vitamin B12 (SOC+B12).
- Viral response–namely, undetectable serum HCV–RNA, was evaluated 4 weeks after starting treatment (rapid viral response), 12 weeks after starting treatment (complete early viral response) and 24 or 48 weeks after starting treatment (end–of–treatment viral response) and 24 weeks after completing treatment (sustained viral response (SVR)).
- Genotyping for the interleukin (IL)–28B polymorphism was performed a posteriori in a subset (42/64) of HCV genotype 1 carriers.
- Overall, rapid viral response did not differ between the two groups, whereas the rates of complete early viral response (p=0.03), end–of–treatment viral response (p=0.03) and SVR (p=0.001) were significantly higher in SOC+B12 patients than in SOC patients.
- In SOC+B12 patients, the SVR rate was also significantly higher in carriers of a difficult–to–treat genotype (p=0.002) and in patients with a high baseline viral load (p=0.002).
- Distribution of genotype IL–28B did not differ between the two groups.
- At multivariate analysis, only easy–to–treat HCV genotypes (OR=9.00; 95% CI 2.5 to 37.5; p=0.001) and vitamin B12 supplementation (OR=6.9; 95% CI 2.0 to 23.6; p=0.002) were independently associated with SVR.