Ribavirin in combination with peginterferon alfa shows strong clinical efficacy against
chronic hepatitis C, and is now established as the standard of care. However, the precise role of
ribavirin is still being defined, suggesting that optimal
ribavirin dose should be maintained over the whole treatment period.
Ribavirin dosage varies by bodyweight for genotype 1 disease (1000mg/day in patients <or =75kg and 1200mg/day in patients >75kg), whereas 800mg/day is sufficient to ensure optimal response in all genotype 2/3 patients. Similarly, genotype 1 patients benefit from 48 weeks of
therapy, while 24 weeks is sufficient for genotype 2/3 disease. Recent data suggest treatment success is dependent on cumulative
ribavirin exposure, as patients who receive <60% of the planned dose have lower response rates, regardless of whether reductions are from temporary interruptions or premature cessation of
therapy. All patients should be monitored for
hemolytic anemia, as early diagnosis allows management through small
dose reductions and stepwise return to the target dose, maximizing cumulative exposure. Despite these recent advances in our knowledge, many questions remain, such as whether the role of
ribavirin will change or even be eliminated as new
therapies are developed.