Patients with HCV whose treatment is supplemented with vitamin B12 may be more likely to experience sustained viral response, according to recent results.
Researchers randomly assigned 94 patients with chronic HCV to receive pegylated interferon-alfa and ribavirin with or without a 5,000 mcg injection of vitamin B12 every 4 weeks (n=47 for each). Serum HCV-RNA levels were evaluated at 4, 12, 24 and 48 weeks during and at 24 weeks after treatment. Achievement of undetectable HCV-RNA levels was considered rapid response at 4 weeks, complete early response at 12 weeks, end-of-treatment response at 24 or 48 weeks, and sustained viral response (SVR) at 24 weeks following treatment conclusion. The cohort included patients with HCV genotypes that were both easier (2 or 3) and more difficult (1 or 4) to treat.
Rapid response occurred in 32 patients with and 23 without supplementation, which was not a statistically significant difference. Compared with patients not receiving B12 supplementation, more patients in the group receiving B12 experienced complete early viral response (85% vs. 64% of patients, P=.03), end of treatment response (83% vs. 63%, P=.03) and SVR (72% vs. 38%, P=.001).
SVR also was higher in the supplementation group among those with a more difficult-to-treat HCV genotype (63% vs. 22% among patients with genotype 1b or 1a, P=.002) and with a higher viral load at baseline (70% vs. 32% for more than 500,000 U/L, P=.002) Multivariate analysis indicated independent associations between SVR and B12 supplementation (OR=6.9; 95% CI, 2.0%-23.6%) and easily-treated HCV genotypes (OR=9.00; 95% CI, 2.5%-37.5%).
“Here we report evidence that vitamin B12 supplementation significantly improves the rate of virological response in patients naive to antiviral therapy,” the researchers wrote. “Until eligibility criteria are well established, the [standard of care] and B12 combination is a safe and inexpensive alternative to improve the rate of SVR in difficult-to-treat patients. This strategy would be especially useful in those countries where, owing to limited economic means, the new-generation antiviral therapies cannot be given in routine clinical practice.”