Pegylated
Interferon Plus Ribavirin in Non-responders to Prior Interferon Therapy
The
management of patients with chronic hepatitis C
who either did not respond or relapsed after prior interferon-based therapy is
a subject of considerable interest and much research. Patients previously treated
with suboptimal therapy (conventional rather than pegylated
interferon, or interferon monotherapy) are particularly likely to benefit
from a subsequent treatment attempt. As
reported in the November 2006 issue of Gut, researchers conducted a multicenter
open-label study to evaluate the efficacy and safety of pegylated
interferon plus ribavirin in HCV positive patients with detectable
HCV RNA who did not respond or who relapsed after previous therapy with conventional
interferon, with or without ribavirin. All
312 patients (212 non-responders and 100 relapsers) were re-treated with 180
mcg/week pegylated interferon alfa-2a (Pegaysy) plus 800 mg/day ribavirin
for 24 or 48 weeks, at the investigators' discretion; 91% received the longer
course of therapy. (This study was designed before research showed that 1000-1200
mg/day was a better ribavirin dose for patients with genotype
1 HCV.) Results 
Baseline characteristics of non-responders and relapsers were similar, although
more non-responders had genotype 1 (87% vs. 69%).
The overall SVR rates were 23% (48 out of 212 patients) for prior non-responders
and 41% (41 out of 100) for relapsers.
When data were analyzed by genotype, overall SVR rates were 24% for patients with
genotype 1 and 47% for those with genotypes 2 or 3.
Conclusion The
authors concluded that, "These 'real world' results in a large patient cohort
demonstrate that it is possible to cure a proportion of previous non-responders
and relapsers by re-treating with [pegylated interferon] plus ribavirin." It
is possible that better results might have been achieved if the higher ribavirin
dose had been used, and if all genotype 1 patients had been treated for 48 weeks.
It is also possible that 24 weeks of therapy might have been adequate for patients
with genotypes 2 or 3. 11/17/06 Reference
M
Sherman, E M Yoshida, M Deschenes, and others. Peginterferon alfa-2a (40KD) plus
ribavirin in chronic hepatitis C patients who failed previous interferon therapy.
Gut 55(11): 1631-1638. November 2006.
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