Pegylated Interferon and Ribavirin Failures: Is Retreatment an Option?

Abstract

Currently, there are limited therapeutic options available for chronic hepatitis C (HCV) patients who fail treatment with peginterferon alpha (PEG IFN) + ribavirin (RBV). An option is retreatment with a second course PEG-IFN + RBV. However, the virologic clearance with this option is unknown. Thus, we evaluated the outcome of our cohort of patients with chronic HCV who achieved a sustained viral response when retreated with PEG IFN plus RBV after having no response to an initial course of PEG IFN plus RBV. Nonresponse to treatment was defined as failure to achieve an early virologic response by week 12 or presence of detectable HCV RNA at week 24 or after completion of PEG-IFN + RBV therapy. Twenty patients (12 [60%] men; 8 [40%] women) were treated with PEG IFN alpha-2b plus RBV and PEG IFN alpha-2a plus RBV. The mean age of the patients was 50 years, 85% were white, 95% had genotype 1, and 35% had cirrhosis. Prior to the first course of PEG IFN plus RBV, 12 (60%) of 20 patients had no prior treatment for Hepatitis C. After the second course of PEG IFN plus RBV, 2 (10%) of 20 patients achieved a sustained virologic response. These results suggest marginal benefit of retreatment of patients with chronic HCV with another course of PEG IFN plus RBV after they have not responded to an initial course of PEG IFN plus RBV.

Evaluation of Treatment Results of Patients with Chronic Hepatitis C Followed for Five Years

“…Çalışmamızda başlangıç HCV RNA sayısının 600 000 İÜ/ml'den düşük ya da yüksek olmasının KVY oranları üzerinde bir etkisi bulunmamıştır. Çeşitli çalışmalarda yeniden tedaviyle farklı başarı oranları bildirilmektedir (12)(13)(14)(15)(16). Jensen ve arkadaşları (17), PEG IFN-α 2b tedavisine yanıtsız kalan hastaları, ribavirine farklı dozlarda ekledikleri PEG IFN-α 2a ile yeniden 48 ve 72 hafta süreyle tedavi etmişlerdir.…”

Retreatment with pegylated interferon plus ribavirin of chronic hepatitis C non-responders to interferon plus ribavirin: A meta-analysis

“…Of the remaining 42 full-text articles, 30 were excluded because they did not meet inclusion criteria, leaving 14 fulllength papers [3][4][5][6][7][8][9][10][11][12][13][14][15][16] meeting criteria for inclusion in the meta-analysis. Finally, 6 abstracts identified by manual search [17][18][19][20][21][22], were also included, only for the evaluation of the publication bias.…”

“…The main features of the trials included in the meta-analysis are shown in Table 2 in Appendix. Fourteen, which accounted for 3898 patients, were reported as full papers [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Among the trials, three studies did not report the number of participating centers, while all remaining studies were multicenter trials, with the number of centers ranging from 2 to 133; among these studies 8 reported data on the prevalence of patients with cirrhosis (357/1282 = 27.8%).…”

“…The sample size of each study varied greatly, ranging from 20 [14] to 1385 [15] patients. Mean patient age was 47.8 years, ranging from 41.8 to 50.2.…”

“…Several studies of retreatment with pegylated IFN (PEG-IFN) plus ribavirin in patients who failed to respond to the combination of pegylated and non-pegylated IFN plus ribavirin have been published [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The results of these studies are inconclusive or conflicting because of the relatively small samples and the differences in patient characteristics, study design combining relapsers and nonresponders, doses of IFN and ribavirin administered in the first course, and retreatment regimens.…”