New pieces to the hepatitis C treatment puzzle

Abstract

T” ATMENT OUTCOME for patients with chronic hepatitis C virus (HCV) infection has greatly improved during recent years with the development of interferon (IFN) and ribavirin combination therapy. Combination therapy with standard doses (IFN-alfa 3 MU t.i.w. plus ribavirin 1000-1200 mg daily in two divided doses) given for 6 (-12) months significantly improves the virological sustained response rates 2-3 times in na’ive patients as compared to IFN monotherapy given for 12 months (1). Combination therapy has thus become standard therapy for nai’ve patients (2,3) and relapse patients after a prior IFN treatment course (4), as recently reviewed at the HCV consensus meeting in Paris in February 1999 (5). For na’ive patients with favorable baseline viral characteristics (genotype 2 and 3) 6 months combination therapy is sufficient, irrespective of baseline viral load, yielding 60-70X virological sustained response (SR). For patients with unfavorable viral baseline characteristics (genotype 1 with high baseline viral load) 48 weeks combination treatment was recommended at the consensus meeting (5). For this latter category, however, results are less than optimal and improvements are needed since only one third will achieve virological SR, even with the prolonged 48 weeks combination treatment (1). Whether 48 weeks IFN+ribavirin combination therapy is superior to 24 weeks for genotype 1 patients with relapse after IFN therapy was not evaluated in the international study initiated by Schering-Plough, where all patients were treated for 24 weeks (4). Only 25% of relapse patients with genotype 1 and high viral load had a virological SR in this study, but improvement with prolonged ther-