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Title: THERAPY OF HEPATITIS C - ALPHA-INTERFERON AND
RIBAVIRIN
Ribavirin is a nucleoside analogue that has been evaluated as a
therapy of chronic hepatitis C alone and in combination with alpha
interferon, Ribavirin is well absorbed orally and is typically
given in doses of 1,000 to 1,200 mg/d, Three randomized, placebo-
controlled studies comprising more than 150 patients have shown
that therapy with ribavirin alone for 24 to 48 weeks resulted in a
significant reduction in serum alanine aminotransferase (ALT)
levels during therapy, However, ribavirin therapy did not lead to a
substantial reduction in hepatitis C virus (HCV) RNA levels; almost
all patients remained viremic, and serum aminotransferase levels
increased to pretreatment values when therapy was stopped, The most
common adverse ev ent was a moderate and reversible hemolysis
during treatment that caused a decrease in hemoglobin by 10% to 20%
of baseline levels. Combination therapy of ribavirin with alpha
interferon has demonstrated promise both in pilot studies and a
recently completed randomized controlled trial, Ribavirin in
standard doses combined with alpha interferon in doses of 3 million
units (MU) three rimes weekly fur 6 months was found to
significantly improve the sustained biochemical and virological
response rates compared with interferon alone, Combination therapy
offers a promise to become standard therapy for patients with
nonsustained response to alpha interferon alone, because tile
majority of such patients achieve a durable response after
treatment with combination therapy, However, nonresponders to alpha
interferon alone rarely achieve a sustained beneficial response to
combination treatment, For interferon-naive patients, combination
therapy is superior to therapy with alpha interferon alone in
achieving sustained biochemical and virological responses, but the
combination demonstrates clear-cut superiority only in patients
with unfavorable profiles for a response to interferon, in
particular patients with high levels of HCV RNA. The optimal use
and regimen of combination therapy awaits further investigation.
New antiviral agents are still needed for the proportion of
patients who do not respond to alpha interferon, even in
combination with ribavirin.
Author: REICHARD O, HUDDINGE HOSP, KAROLINSKA INST, DIV
INFECT DIS, I73 S-14186 HUDDINGE, SWEDEN; Source: HEPATOLOGY 1997
SEP;26(3):S 108-S 111
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