Interferon (IFN) alpha in combination with
ribavirin (RIB) is standard
therapy for patients with
chronic hepatitis C virus (HCV)
infection. However, many patients do not respond with sustained HCV clearance to this
therapy. At present, no accepted treatment strategy exists for these patients. Recent preliminary data have suggested that
amantadine (AMA) is effective against HCV
infection. In a pilot study, we treated 13 nonresponders and 10 response/ relapsers to previous IFN/RIB
therapy with AMA 200 mg per day in combination with IFN 3 MU thrice weekly, and RIB 1000 mg per day for 24 weeks, with a 24-week follow-up period after end-of-treatment. At the end-of-treatment, 1 previous nonresponder and 5 previous response/relapsers were HCV
RNA negative. At the end of follow-up, only 1 previous response/relapser remained HCV
RNA negative and had a sustained response. During
therapy, serum HCV
RNA became undetectable in 4 previous nonresponders, of whom 3 had a breakthrough at week 24. Twenty-one patients continued
therapy without
dose reductions. One patient discontinued
therapy prematurely due to sleeping disturbances, and another patient was withdrawn from
therapy due to heavy alcohol intake. We conclude that the addition of AMA to IFN and RIB was well tolerated but had little, if any, impact on HCV
RNA eradication in nonresponders or response/relapsers to previous IFN/RIB combination
therapy.