Alimentary Pharmacology and Therapeutics Letters to the Editors SIRS, We appreciate the response to our article1 offered by Furnari et al., including their recognition of our efforts to summarise the effectiveness of antibiotic therapy for small intestinal bacterial overgrowth (SIBO).2 We agree that the lack of statistical significance in the meta-analysis of rifaximin vs. placebo is likely due to the small number of included studies and subjects. Their points regarding lactulose vs. glucose breath testing, and the inclusion of patients with coexisting functional and organic gastrointestinal disorders are also well made. The motivation to perform our study was a pragmatic one. Our clinical experience was that many of our patients reported symptoms suggestive of SIBO; yet, the ideal antibiotic regimen remained unclear. As such, we felt that a summary of the evidence for antibiotic therapy in SIBO would be useful to ourselves and to others. Although our study could not identify the ‘ideal’ antibiotic regimen for SIBO, we believe that it does summa-

Letter: pitavastatin supplementation of PEG-IFN/ribavirin improves sustained virological response against HCV S. Yokoyama, Y. Kawakami & K. Chayama Department of Gastroenterology and Metabolism, Applied Life Sciences, Institution of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. E-mail: [email protected] doi:10.1111/apt.12605

SIRS, Hwang et al.1 reported a retrospective analysis of rapid virological responses (RVR) for hepatitis C virus (HCV) patients with PEG-IFN/ribavirin. RVR rates were lower in patients with lower platelet counts, total cholesterol levels and low-density lipoprotein levels. RVR rates of genotype-1 patients were independent of statins. We performed a retrospective analysis of PEG-IFN/ ribavirin therapy in the presence or absence of pitavastatin. Duration of treatment was determined by patient response: patients with undetectable HCV RNA at week 12 continued treatment until week 48; patients with detectable HCV RNA at week 12 continued treatment until week 72. Thirty-seven pitavastatin-treated patients and seventy-one controls were evaluated by

Aliment Pharmacol Ther 2014; 39: 440-445 ª 2014 John Wiley & Sons Ltd

rise the existing data, and, importantly, highlights the shortcomings of the current literature – which Furnari et al. also nicely summarise. Like Furnari et al. we hope that future studies of SIBO therapy will conform to a more uniform and comparable standard so that management of SIBO can be optimised.

ACKNOWLEDGEMENT The author’s declarations of personal and financial interests are unchanged from those in the original article.1 REFERENCES 1. Shah SC, Day LW, Somsouk M, Sewell JL. Meta-analysis: antibiotic therapy for small intestinal bacterial overgrowth. Aliment Pharmacol Ther 2013; 38: 925–34. 2. Furnari M, Savarino V, Savarino E. Letter: treatment for small intestinal bacterial overgrowth – where are we now? Aliment Pharmacol Ther 2014; 39: 442.

per-protocol (PP) analysis. Of 37 patients completing pitavastatin treatment, 23 underwent treatment for 48 weeks and 14 for 72 weeks. Of 71 controls completing treatment, 61 underwent treatment for 48 weeks and 10 for 72 weeks. There was no significant difference in sustained viral response (SVR) rate by PP analysis: 56.8% pitavastatin group vs. 36.6% control, P = 0.21. Pitavastatin patients with serum total cholesterol