A randomized controlled trial adding fluvastatin to peginterferon and ribavirin for naïve genotype 1 hepatitis C patients

• Published in: Journal of viral hepatitis Vol. 20; no. 9; pp. 622 - 627
• Main Authors: Bader, T., Hughes, L. D., Fazili, J., Frost, B., Dunnam, M., Gonterman, A., Madhoun, M., Aston, C. E.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-09-2013; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Antiviral Agents - administration & dosage; Antiviral Agents - adverse effects; Drug Therapy, Combination - methods; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - pathology; Fatty Acids, Monounsaturated - administration & dosage; Fatty Acids, Monounsaturated - adverse effects; fluvastatin; Genotype; Hepacivirus - classification; Hepacivirus - genetics; hepatitis C; Hepatitis C - drug therapy; Hepatitis C - virology; Hepatitis C virus; Humans; Indoles - administration & dosage; Indoles - adverse effects; Interferon-alpha - administration & dosage; Interferon-alpha - adverse effects; Male; Middle Aged; peginterferon alfa; Polyethylene Glycols - administration & dosage; Polyethylene Glycols - adverse effects; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; ribavirin; Ribavirin - administration & dosage; Ribavirin - adverse effects; simvastatin; Treatment Outcome; simvastatin; ribavirin; peginterferon alfa; fluvastatin; hepatitis C
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/jvh.12085

Summary
Fluvastatin or simvastatin has demonstrable antiviral activity against hepatitis C virus (HCV) as monotherapy. The safety and efficacy of adding fluvastatin or simvastatin to peginterferon/ribavirin for 48 weeks was tested in HCV genotype 1 naïve‐to‐treatment veterans. Thirty‐seven naïve‐to‐treatment genotype 1 HCV patients were randomized to either a control group (n = 20) to receive peginterferon alfa plus ribavirin or an experimental group (n = 18) to similarly receive peginterferon alfa plus ribavirin as well as fluvastatin 20 mg/day. In addition, seven patients who presented for HCV treatment already were on simvastatin and could not be withdrawn. These simvastatin users were not randomized but were entered into a concurrent prospective pilot arm. There were no unique safety issues with fluvastatin or simvastatin when these drugs were given with peginterferon/ribavirin for 48 weeks. Thirteen of 25 statin patients achieved sustained viral response (SVR), while 5 of 20 control patients achieved SVR. Analysis of SVR by intention‐to‐treat showed P = 0.078. In this phase 2 study, there were no safety issues with the addition of fluvastatin or simvastatin to peginterferon and ribavirin for 48 weeks. There was a trend towards improvement in SVR when fluvastatin or simvastatin was administered with peginterferon/ribavirin. The size of the groups did not reach the prestudy size thought needed to show significant difference (type II error). These results support the significant results of two other larger randomized controlled trials reported using the same dose of fluvastatin in naïve‐to‐treatment genotype 1 HCV patients.