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High sustained virological response in chronic hepatitis C by combining induction and prolonged maintenance therapy
Author(s) -
Vrolijk J. M.,
Bekkering F. C.,
Brouwer J. T.,
Hansen B. E.,
Schalm S. W.
Publication year - 2003
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1046/j.1365-2893.2003.00408.x
Subject(s) - ribavirin , medicine , regimen , gastroenterology , viral load , cirrhosis , pegylated interferon , interferon , hepatitis c , alpha interferon , maintenance therapy , hepatitis c virus , immunology , virus , chemotherapy
Summary. Chronic hepatitis C patients with genotype 1 infection, liver cirrhosis, high viral load, or those who have not responded to anti‐viral treatment in the past have limited chances of clearing the virus, even with pegylated interferon–ribavirin therapy. In this study we treated such patients with a treatment schedule that combines high dose induction Interferon (IFN), prolonged daily IFN and ribavirin treatment. Twenty‐four consecutive patients were included in this study with either genotype 1 infection, cirrhosis, previous non‐response to IFN or a combination of these poor‐response characteristics. Patients were treated with 10 million units (MU) of IFN daily for 4 weeks followed by 5 MU/day until week 24, 3 MU/day until week 52 and 3 MU thrice weekly until week 76 in combination with 1–1.2 g ribavirin daily. HCV RNA levels were assessed weekly until week 4 and at least once every 3 months thereafter, by a validated assay with a detection limit below 500 copies/mL. Both intention to treat (ITT) and per protocol (PP) analysis showed a high sustained virological response (ITT 67%, PP 80%). A virological response occurred rapidly (before 8 weeks of treatment) in all patients with a sustained response. Relapse after stopping therapy was observed in only 5%. Side‐effects were observed frequently, and six patients had to be hospitalized. With this new treatment regimen that combines induction‐ and prolonged daily interferon treatment with ribavirin it seems possible to eliminate hepatitis C virus in the majority of patients that have an a priori limited chance of sustained response. Further clinical evaluation of intensive interferon and ribavirin combination therapy (now also including PEG‐interferon) is recommended in centres that can provide close patient monitoring and experienced hepatological support.