Therapy of chronic hepatitis C: a critical review.

Abstract

Combination therapy (Interferon plus ribavirin) is the current therapeutic gold standard for naive Hepatitis C Virus (HCV)-positive patients and with the recent advent of pegylated (PEG) IFN the rate of the sustained virological response (HCV-RNA clearance 6 months after the end of treatment) is about 54%-56% with a therapeutical gain mainly among patients with unfavourable HCV genotype (1a, 1b); in this subset of patients, a 42%-46% sustained response rate is achieved compared with 33%-36% found among genotype 1 patients treated with the standard therapy. Patients who respond to IFN monotherapy but relapse during the follow-up should be re-treated with combination therapy given for at least 6 months at the minimum dose of 3 MU thrice weekly plus ribavirin 1000 mg/daily. Recent data suggest that prolonging the time of treatment (12 months) may induce a significantly higher rate of sustained response among patients with genotype 1. The efficacy of the combination of IFN and ribavirin in retreating patients with chronic hepatitis C not responding to IFN monotherapy is controversial as it ranges between 0% and 40%. Recent data show an overall rate of sustained response of 23% when an aggressive approach is adopted but increasing the dosage and the time of treatment induces a significant therapeutic benefit only in patients with genotype 1. In conclusion, a therapeutic progress for chronic hepatitis C has been achieved during the last 10 years (56% vs 20% of sustained response rate obtained with IFN monotherapy) but several unresolved issues are yet to be addressed.

• Authors: G Saracco, A Olivero, A Ciancio, S Carenzi, M Rizzetto
• Journal: Current drug targets. Infectious disorders (Curr Drug Targets Infect Disord) Vol. 3 Issue 1 Pg. 25-32 (Mar 2003) ISSN: 1568-0053 [Print] Netherlands
• PMID: 12570730 (Publication Type: Comparative Study, Journal Article, Review)

Chemical References

• Interferon-alpha
• Ribavirin
• Alanine Transaminase

Topics

• Age Factors
• Alanine Transaminase (blood)
• Animals
• Blood Coagulation Disorders, Inherited (complications)
• Depressive Disorder (complications)
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Female
• Genotype
• Hepatitis C, Chronic (blood, complications, drug therapy)
• Humans
• Interferon-alpha (adverse effects, therapeutic use)
• Pregnancy
• Recurrence
• Renal Insufficiency (complications)
• Ribavirin (therapeutic use)
• Treatment Outcome