Pegylated Interferon and Ribavirin Dosing Strategies to Enhance Sustained Virologic Response

Abstract

Hepatitis C virus (HCV) affects about 170 million people worldwide and is the most common chronic blood borne infection in the United States. Since the advent of blood screening protocols in the early 1990s, injection drug use has become the leading cause of infection. Hepatitis C can have both hepatic and nonhepatic manifestations of infection. Hepatic manifestations include hepatic fibrosis, cirrhosis, liver cancer, and liver failure. The standard treatment for chronic HCV is combination therapy with pegylated interferon-α and ribavirin. Although pegylated interferon and ribavirin has been used against HCV for close to a decade, advances in therapy have centered on doses and treatment durations. There has been increasing interest in applying on-treatment response or viral kinetics to predict antiviral response rates and shape therapeutic intervention. Protease inhibitors are a promising adjuvant to combination therapy, but their efficacy and safety are still under investigation.

Management of Hepatitis C Antiviral Therapy Adverse Effects

“…Intervention for ribavirin-induced anemia depends on the rate of hemoglobin decrease, absolute hemoglobin value, comorbidities, and symptoms. Therapeutic options include frequent monitoring, blood transfusion, erythropoietin grown factor, and ribavirin dose modification [ 6 •, 8 ••, 50 ••]. The risk of significant anemia can be predicted by hemoglobin trends.…”

“…These complications can severely compromise quality of life [ 7 ]. Both interferon and ribavirin are associated with signature effects that are predictable, manageable, and improve with dose modification or discontinuation [ 8 ••]. Rarely is an adverse effect from hepatitis C antiviral therapy permanent.…”

Hepatitis C Infection in the Elderly

“…The backbone of HCV therapy over the past decade has been the use of pegylated interferon (PegIFN) and Ribavirin (RBV) [16]. However, interferon therapy poses many challenges in elderly patients and those with advanced liver disease because of limited efficacy, safety, and tolerability [11].…”

Can laboratory parameters be predictive factors for treatment effectiveness of patients suffering from viral hepatitis C?

“…Temat ten wydaje się ważny wobec wprowadzania nowych metod terapii. Istotne jest przewidywanie powodzenia terapii u cho-rego [8,9,10,11,12,13,14,15,16]. Znanymi czynnikami pogarszającymi rokowanie są: zaawansowanie choroby wątroby, zakażenie genotypem 1 i 4 HCV (Hepatitis cytomegalo-virus), wysoka wiremia przed leczeniem, starszy wiek, płeć męska oraz otyłość i zespół metaboliczny.…”