Treatment of chronic hepatitis C in nonresponders to interferon monotherapy

Abstract

Sixty percent of patients fail to respond to interferon monotherapy. African-Americans with hepatitis C appear to respond less well to interferon monotherapy. Retreatment with a higher dose of consensus interferon for 48 weeks has led to a sustained virologic response rate of 13%. As a group, interferon nonresponders who breakthrough while on interferon monotherapy seem to have a more favorable response rate to a repeat course of treatment. Retreatment with interferon and ribavirin for 6 months in nonresponders led to a sustained virologic response rate of 21%. Preliminary results from two trials in the United States demonstrate similar treatment efficacy. There is now evidence that maintenance interferon therapy may also be beneficial in interferon monotherapy nonresponders.

Pegylated Interferon and Ribavirin Failures: Is Retreatment an Option?

“…For example, the retreatment with IFN of patients after IFN failure resulted in an SVR of about 2% (10 of 443; 95% confidence interval, 1-4%) [4]. Patients retreated with a different form of IFN showed a higher response rate (13.0-18.6%) [5,6]. When IFN nonresponders were treated with a combination of IFN and RBV, the resulting SVR was 13-21% [4,7] (higher with a 48-week treatment and higher in patients who were non-type 1 genotypes).…”

Therapy for treatment-refractory chronic hepatitis C virus genotype 1b infection: A retrospective analysis

“…22,23 Consensus IFN (ie, IFN alfacon-1, a recombinant, synthetic type 1 IFN) has been reported to be a suc-cessful therapy for standard IFN failures; however, this drug is not available in many countries. [24][25][26][27] Although few published trials evaluating the role of peg-IFN + RBV in IFN nonresponders or relapsers are available, it is thought that SVR rates might be improved with this treatment. Preliminary data from the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial 3 were published in 2002.…”

Treatment of chronic hepatitis C in nonresponders to previous therapy

“…Implementation of weight-based dosing is also resolving differences in response between male and female patients, suggesting that disparate weight between the genders and not the gender itself is the confounding factor [13]. Infection with HCV genotype 1 and serum levels of HCV-RNA greater than 2 million copies/mL are associated with nonresponse [4••,8•, 14,15]. Although treatment with IFN has been associated with lower response rates in patients with bridging fibrosis and cirrhosis, combination therapy with ribavirin plus IFN or PEG-IFN has yielded significant SVR rates in these patients [4••, 16•].…”

“…Retreatment of nonresponders to standard IFN monotherapy (3 MU three times a week) with high-dose IFN, daily IFN, and consensus IFN has been reviewed [8•, 15,17]. Although these therapies often yield impressive on-treatment virologic responses in treatment-naïve patients, sustained virologic responses are rarely improved, and more side effects are reported with high-dose and daily regimens [8•].…”