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January 2000
Chronic Hepatitis C VIRUS (HCV) Infection
Therapy with pegylated interferon alfa-2a (PEG-IFN) and
ribavirin. M. Sulkowski et al. treated 20 patients with chronic HCV
infection with a combination of PEG-IFN (Hoffman-La Roche, Inc.)
180 ug SC weekly plus oral ribavirin 1000-1200 mg daily x 24-48
weeks. By week 24, serum ALT levels had normalized in 80% (16/20)
of patients and serum HCV RNA had become undetectable in 84%
(16/19) of patients. Adverse events occurred with a similar
frequency in fasting (n=10) and nonfasting (n=10) patients, and no
patients were discontinued due to anemia or neutropenia. In this
small pilot study, PEG-IFN plus ribavirin had good antiviral
activity and was well tolerated. A large multicenter trial of
combination therapy is ongoing and will hopefully confirm these
encouraging preliminary results. (Sulkowski M, et al. Hepatology
1999; 30: 197A)
Maintenance interferon therapy for nonresponders with persistent
viremia. Hepatic histological improvement has been observed to
occur in some patients with chronic HCV infection treated with
interferon or interferon/ribavirin despite continued viremia at the
end of therapy, i.e., nonresponders. Mitchell Schiffman and
colleagues studied patients who remained HCV RNA positive but had a
histological response after 6 months of interferon alfa-2b therapy.
These patients were randomized to either continue (n=27) or
discontinue interferon treatment (n=26) to determine if maintenance
interferon (3 MU 3 x weekly) prevents histological progression.
After 30 months, 30% of untreated patients had worsening of
histology (p less than 0.01), while 80% of the interferon-treated
patients experienced further histological improvement (p less than
0.03). These data show that maintenance interferon therapy may
benefit the subgroup of nonresponders to interferon therapy who
demonstrate a hepatic histological response in spite of persistent
viremia.
(Schiffman M, et al. Gastroenterology 1999; 117:
1164-1172)
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