Update on Hepatitis C Treatment

, Clinical Instructor, UCLA School of Medicine, Los Angeles, California, and , Medical Director, Liver Transplantation, Cedars-Sinai Medical Center, Associate Professor of Medicine, UCLA School of Medicine, Los Angeles, California

Disclosures

February 15, 2001

In This Article

Interferon Monotherapy

IFN-alfa 2 was the first agent approved for the treatment of chronic HCV. Since the initial trials establishing its efficacy, data regarding treatment duration and dose have evolved. Currently, 2 forms of IFN-alfa that differ by a single amino acid residue are approved for treatment of chronic HCV infection: IFN-alfa 2b (Schering-Plough, Kenilworth, New Jersey) and IFN-alfa 2a (Hoffmann-La Roche, Basel, Switzerland). The recommended dose is 3 million units 3 times each week for up to 12 months.

When used alone in monotherapy, the alfa interferons have similar efficacies, with SRs of only 10% to 20%, with the modestly higher response rates associated with more prolonged therapy. Higher-dose IFN-alfa (ie, > 9 million units per week) results in SRs between 8% and 20% in treatment-naive patients. High-dose IFN-alfa has also been studied in NRs and relapsers, but with mixed results. With prior NR, SRs achieved with higher doses are only between 0% and 4%. In relapsers, SRs range from 20% to 40%. However, side effects are more troublesome with higher doses.[8]

Because of the low overall response rate to standard IFN-alfa, more recent studies have focused on newer regimens, including synthetic IFN (IFN alfacon-1), "combination" therapy (IFN-alfa 2b + ribavirin), and longer-acting IFNs (pegylated IFNs). A number of major pretherapy predictors of NR have been identified, notably HCV genotype 1, the presence of cirrhosis, and higher viral load.[9] In addition, patient's race appears to affect response to IFN, with African Americans having an overall low SR to therapy.[10]

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