Therapy of hepatitis C: Re‐treatment with alpha interferon

• Published in: Hepatology (Baltimore, Md.) Vol. 26; no. S3; pp. 137S - 142S
• Main Authors: Alberti, A, Chemello, L, Noventa, F, Cavalletto, L, De Salvo, GianLuca
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-09-1997; Wiley
• Subjects: Antiviral Agents - therapeutic use; Biological and medical sciences; Chronic Disease; Forecasting; Hepatitis C - blood; Hepatitis C - therapy; Humans; Immunomodulators; Interferon-alpha - therapeutic use; Medical sciences; Pharmacology. Drug treatments; Recurrence; Retreatment; Human; Relapse; Withdrawal; Treatment efficiency; Hepatic disease; Reprocessing; Infection; Virus; Chronic; Viral disease; Immunotherapy; Digestive diseases; Interferon; Flaviviridae; Hepatitis C virus; Viral hepatitis C
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.510260724

The long‐term benefit of interferon therapy in chronic hepatitis C is limited. During therapy, serum alanine aminotransferase (ALT) levels decrease to normal and hepatitis C virus (HCV) RNA decreases in 40% to 60% of patients. However, most patients relapse after therapy withdrawal, so that no more than 15% to 25% achieve a sustained response. Re‐treatment has been evaluated in studies using different regimens and forms of alpha interferon in different cohorts of patients at different times after initial therapy. Both end‐of‐treatment and sustained responses to re‐treatment correlate with the type of response achieved during the initial course. Patients who do not respond or have only a partial response to the initial course of interferon have an extremely low rate of sustained response when re‐treated, independently of the regimen used. Combining data from 13 studies, sustained responses occurred in no patients who were re‐treated with 3 million units (MU) three times weekly for 6 months, and in only 2% to 3% of patients re‐treated with higher doses and/or for longer periods. In contrast, a significant number of patients who responded during the initial course but subsequently relapsed have a sustained response when re‐treated with interferon alone. Combining data from 11 published studies on patients who relapsed after an initial course, sustained responses occurred in 15% (95% confidence interval [CI], 10%‐20%) of patients re‐treated with 3 MU three times weekly for 6 months, in 29% (CI, 17%‐40%) re‐treated with a higher dose for 6 months, and in 43% (CI, 34%/50%) re‐treated for at least 12 months. On the other hand, patients who relapsed after a 12‐month course of interferon had only 4% rate (range, 0%‐8%) of sustained response when re‐treated. The best predictor of sustained response to re‐treatment in patients who had relapsed was a negative serum HCV‐RNA test by polymerase chain reaction at the end of the first course. These results, which have been confirmed in a recent prospective, randomized controlled trial, indicate that nonresponders to interferon should not be re‐treated with interferon alone, whereas patients who relapse after a 6‐month course of alpha interferon therapy have an indication to be re‐treated for at least 12 months, especially if serum HCV RNA was negative at the end of the first course of treatment.