Consensus Interferon and Ribavirin in Patients with Chronic Hepatitis C Who Were Nonresponders to Pegylated Interferon alfa-2b and Ribavirin

Abstract

Recent studies suggest that consensus interferon and ribavirin is effective in retreating patients with chronic hepatitis C who failed therapy with interferon alfa and ribavirin. The objective of the present study was to assess the efficacy, safety, and tolerability of consensus interferon and ribavirin in patients who did not respond to pegylated interferon alfa-2b and ribavirin. We retrospectively identified 137 consecutive nonresponders to pegylated interferon alfa-2b and ribavirin and initiated patients on daily treatment with consensus interferon 15 mug subcutaneously and weight-based ribavirin for 48 weeks. If patients were HCV RNA negative at 12 weeks, the dose was reduced to 15 mug three times weekly for the remaining 36 weeks. The sustained virologic response rate was 37%. Daily consensus interferon therapy was safe and well tolerated in all patients. No dose reductions were required, and no patient discontinued therapy. Further studies of consensus interferon and ribavirin in nonresponders are warranted.

Retreatment of Hepatitis C with Consensus Interferon and Ribavirin After Nonresponse or Relapse to Pegylated Interferon and Ribavirin: A National VA Clinical Practice Study

“…These include the absence of effective alternative therapies, patient motivation, tolerability of prior PEG-IFN/RBV, severity of liver disease and perceived risk of disease progression, and variations in the availability of this therapy between VA facilities. CIFN was dosed almost exclusively as 15 mcg subcutaneous daily with RBV, the doses which tended to be used in the single center trials [13][14][15][16]. The use of erythropoietic growth factors and/or granulocyte colony stimulating factors in 49% of patients reflects both the hematological toxicity of this therapy, as well as the clinical judgment by providers that continuation of CIFN/RBV was important enough to warrant the use of these agents.…”

“…The use of erythropoietic growth factors and/or granulocyte colony stimulating factors in 49% of patients reflects both the hematological toxicity of this therapy, as well as the clinical judgment by providers that continuation of CIFN/RBV was important enough to warrant the use of these agents. Nonetheless, patients were only treated with CIFN/RBV for an average of 21 weeks, a shorter duration than in other published studies [13,[15][16][17][18]. Twenty four percent of patients discontinued CIFN/RBV within 4 weeks of its initiation.…”

“…Small, single-center, open-label studies demonstrated SVR in 23-37% of patients who were retreated with CIFN/RBV after failing PEG-IFN/RBV. Variations in retreatment strategies have included the use of highdose CIFN (15-27 mcg daily), extending the CIFN/RBV treatment duration to 72 weeks, and switching to CIFN/ RBV immediately upon failure of PEG-IFN/RBV therapy [13][14][15][16]. Retreatment response to CIFN/RBV was particularly low in one study of PEG-IFN/RBV nonresponders with advanced liver disease, only 18% of whom achieved SVR [17].…”

“…Retreatment response to CIFN/RBV was particularly low in one study of PEG-IFN/RBV nonresponders with advanced liver disease, only 18% of whom achieved SVR [17]. Early discontinuation rates were low at 3-14% across these studies [13][14][15].…”

“…Although daily CIFN/RBV has been heralded as a viable option to retreat patients who fail PEG-IFN/RBV, marked variability in SVR rates and drug tolerability have been reported [13][14][15][16][17][18]. In contrast to results from earlier openlabel retreatment studies using CIFN/RBV, SVR rates in the DIRECT trial were similar to PEG-IFN/RBV retreatment [8,18].…”