Antiviral effect of ribavirin in early non-responders to interferon monotherapy assessed by kinetics of hepatitis C virus RNA and hepatitis C virus core antigen

• Published in: Journal of hepatology Vol. 39; no. 5; pp. 826 - 833
• Main Authors: Lunel, Françoise, Veillon, Pascal, Fouchard-Hubert, Isabelle, Loustaud-Ratti, Véronique, Abergel, Armand, Silvain, Christine, Rifflet, Hervé, Blanchi, Alain, Causse, Xavier, Bacq, Yannick, Payan, Christopher
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-11-2003
• Subjects: Adult; Amantadine - therapeutic use; Antiviral Agents - therapeutic use; Chronic hepatitis C virus hepatitis; Drug Resistance, Viral; Drug Therapy, Combination; Female; Hepacivirus - genetics; Hepacivirus - immunology; Hepacivirus - isolation & purification; Hepatitis C Antigens - blood; Hepatitis C virus core antigen; Hepatitis C virus RNA; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - virology; Humans; Interferon; Interferon alpha-2; Interferon-alpha - therapeutic use; Kinetics; Male; Middle Aged; Predictive Value of Tests; Recombinant Proteins; Retreatment; Ribavirin; Ribavirin - therapeutic use; RNA, Viral - blood; Treatment Outcome; Viral Core Proteins - blood; Viral Load; Chronic hepatitis C virus hepatitis; Hepatitis C virus core antigen; Hepatitis C virus RNA; Interferon; Ribavirin
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/S0168-8278(03)00402-1

Background/Aims: To evaluate the efficacy of ribavirin, given in second intention in non-responders to interferon alone, by studying viral kinetics.
Methods: We conducted a trial including 203 patients with chronic hepatitis C, naı̈ve of treatment. Patients were treated with interferon three times a week with or without ribavirin and amantadine according to response. Viral kinetics were assessed by serial measurements of HCV RNA (bDNA 3.0 and Monitor 2.0) and a new assay,
trak-C, able to quantify total Hepatitis C virus (HCV) core antigen.
Results: A significant initial drop in HCV RNA or HCV core antigen, under interferon alone, was associated with response to therapy, −4.85±1.33 log for HCV RNA in sustained responders versus −1.86±1.53 log for others groups,
P<0.001. In patients receiving ribavirin in second intention, we also observed a similar drop in HCV RNA and HCV core antigen, predictive of sustained response, −2.67±1.26 log for HCV RNA in sustained responders versus −0.44±0.49 log in non-responders,
P<0.001.
Conclusions: Ribavirin has probably an additional antiviral effect in interferon treated patients. Kinetics of HCV RNA and HCV core antigen under treatment are highly predictive of a sustained virological response.