Abstract
Treatment failure with interferon and ribavirin is seen in over 50% of patients with advanced fibrosis and cirrhosis. Maintenance therapy with IFN has been suggested as an option to prevent disease progression in these treatment failures. Three large clinical trials evaluating maintenance therapy with low-dose pegylated interferon have been completed. None of the studies demonstrated either regression or lack of progression of fibrosis. However, both HALT-C and EPIC3 showed an improvement in necroinflammatory score in patients receiving IFN compared to observation alone. More importantly, none of the studies by intent to treat showed a reduction in clinical events in patients receiving maintenance IFN therapy. Subgroup analysis for both EPIC3 and COPILOT did show some benefit in patients with portal hypertension with a reduction in both liver failure and portal hypertensive bleeding. Side effects are common and dose reduction/discontinuation frequent (up to 50%) in these 3–4 year treatment programs. This chapter evaluates these trials and the potential role of maintenance therapy in patients with HCV and advanced fibrotic liver disease.
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