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.

Virological effects and safety of combined double filtration plasmapheresis (DFPP) and interferon therapy in patients with chronic hepatitis C: A preliminary study

“…Using this approach, the SVR is increased in approximately 50% of patients [20]. However, in the other half, HCV viremia persists and, although…”

Clinical Trial Results of Peginterferons in Combination with Ribavirin

“…A frequent criticism of these trials is that the dose of standard IFN (3 MU) given in the comparator arm was too low. Although this is the FDA-approved dose in the United States, European studies performed in areas of high genotype 1b prevalence 15 show that higher doses of IFN (5-6 MU tiw or oad) obtain better results than the standard schedule. We recently performed a multicenter study involving 313 treatmentnaive patients with chronic hepatitis C genotype 1.…”

Rapid detection of HCV genotyping 1a, 1b, 2a, 3a, 3b and 6a in a single reaction using two-melting temperature codes by a real-time PCR-based assay

“…The response rate to this therapy differs among patients as the HCV genotype is a strong prognostic factor for sustained virological response (Blum, 2003;Saracco et al, 2003;Seeff and Hoofnagle, 2003). It is observed that patients with genotype 2 and 3 have a two-to three-fold higher response rate than patients infected with genotype 1 (Ghany et al, 2009;Poynard et al, 1998).…”